Caring for Someone with Diabetes
Are you taking care of someone with diabetes?
It is good to have a basic understanding of the disease and how to manage it. This will boost your confidence and improve the care of your patient or loved one.
What is diabetes?
Our cells need sugar (or glucose) to function. Sugar enters the cells with the help of a hormone called insulin. Insulin is naturally produced by the pancreas. When someone has diabetes, it means they lack the insulin and thus cannot get sugar into their cells. Instead, the sugar stays in the blood causing what we know as “high blood sugar.”
What is the difference between Type 1 and Type 2 Diabetes?
It is good to know the differences between these two “types” because it could impact the way you care for these individuals.
In type 1 diabetes a person’s pancreas cannot produce insulin. Often, it is diagnosed at a young age and cannot be prevented. These people must be on insulin for their entire life. About 5% of people with diabetes have type 1. It is common for people with type 1 to use an insulin pump. This is an electronic device that remains connected to the person and delivers insulin in response to blood sugar levels. It is also more common for type 1 diabetics to “count carbs” and base the insulin dose on the amount of carbs to be eaten at a meal.
Type 2 diabetes affects a much larger population of diabetics, about 90-95%. A person with type 2 diabetes has a functional pancreas that produces normal insulin but due to diet, lifestyle, and inherited traits the body’s cells start to resist insulin and cannot use insulin properly. This can happen when a person has consistently high blood sugars, so the pancreas is sending out more and more insulin to deliver the sugar to the cells. In time, the cells become less responsive to the insulin causing the pancreas to send out less and less insulin. This ultimately results in higher and higher levels of sugar staying the in blood. If this is discovered early, it can be slowed down. Diet reduces the amount of sugar in the blood and exercise prompts the body to use more sugar up. People with type 2 diabetes don’t usually need insulin shots right away. They can still make some insulin on their own. So, blood sugars are controlled with diet, exercise, and oral medication. If these are not effective, they may need to start insulin shots.
Why is high blood sugar bad?
Frequent high blood sugars over time can lead heart disease, kidney disease, vision loss, neurological damage, and blood vessel damage. So, it is vitally important that blood sugars be adequately controlled with medications, diet, and exercise.
Why is low blood sugar bad?
Low blood sugar is called hypoglycemia and is defined as a blood glucose below 70. If low blood sugar goes untreated it can lead to seizure, loss of consciousness or death. Usually low blood sugars occur when a diabetic takes their medication, such as insulin, but then does not eat. Blood sugar can also drop with exercise, so it is important to have a snack nearby. If blood sugar is below 70, it is important to consume sugar immediately. Continue checking the blood sugar to make sure it remains at a safe level.
As a caregiver you should become familiar with the symptoms of hypoglycemia and take note of what symptoms the person is having.
Another danger associated with low blood sugars is “hypoglycemia unawareness.” This occurs when a person experiences hypoglycemia on a regular basis causing them to become less and less sensitive to the symptoms. Hypoglycemia with no physical symptoms is a very bad thing. This can worsen over time and put the person in danger of severe or life-threatening hypoglycemia. Hypoglycemia unawareness can be reversed. Talk to a doctor if this is a concern.
Is there a certain blood sugar goal?
Yes, there are routine blood tests that the doctor will order to see if overall blood sugar control is effective. However, there is no one size fits all approach to treating diabetes. Each patient is different. Doctors will usually take a “patient centered” approach to choosing medications and doses. That means depending on the patient and their other diseases/health concerns the doctor may be more or less aggressive in blood sugar treatment. It is important to communicate with the health care provider. You can help by sending in blood sugar logs to the doctor for review.
What is prediabetes?
It is estimated that 88 million adults have prediabetes. That is 34.5 % of the adult US population! Doctors will routinely screen people for type 2 diabetes. This could lead to the diagnosis of prediabetes. This means that blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. This is a good warning to make some lifestyle changes such as diet and exercise.
Your role is important!
Diabetes is a complicated disease and can cause stress. Demands such as medication dosing, monitoring blood sugars, and managing food intake can be a lot to balance. This is called “diabetes distress” and has been shown to negatively impact the progression of the disease in individuals. It is important that people with diabetes have support from family, caregivers, and their health care team. It can make such a difference in their outcome.
American Diabetes Association’s Standards of Medical Care in Diabetes-2019, vol 37, n1