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Diabetes management in the elderly

Managing diabetes isn't easy, whether you're young or old. It's always difficult to change your lifestyle in any way – more so if you have done things in a particular way for many years.

But managing diabetes well can really go a long way to ensuring a healthier life in elderly diabetics. Uncontrolled blood-glucose levels compound conditions such as high blood pressure, circulatory disorders, heart problems and eye problems – conditions often found in the elderly.

There are four areas of diabetes management: exercise, diet, blood-glucose control and medication. Sticking to the following tips can make your life a lot easier:

Stay active
All diabetics, whether young or old, need regular, fairly moderate exercise. It's much better to walk for half an hour every day than to do a once-a-week marathon gym session. The latter could in fact be harmful to your health.

Look after your feet
Choose the type of exercise that isn’t hard on your feet. Blisters, cuts and foot infections can spell serious trouble for diabetics. Swimming is good, as is cycling and gentle walking.

Pick your shoes carefully
Make sure your shoes fit properly and that they're comfortable to walk in. The last thing a diabetic wants is an injury from an ill-fitting shoe. Infections or cuts in your feet can start off a chain reaction that can have serious long-term effects. Invest in well-fitting shoes, even if they're costly.

Manage your weight
Remember that diabetes can't be cured, but that you can control it very effectively. Having the correct weight goes a long way to making this condition manageable. Consult your doctor about healthy weight-loss diets. Remember that a crash diet can be fatal.

Eat regular meals
Never skip a meal or eat much later than usual. This can cause your blood-glucose levels to drop and cause many unpleasant symptoms, the worst of which is a diabetic coma. Small, regular meals are preferable to one large one.

Snack often
To correct low blood sugar, you should always carry something sweet with you wherever you go. Raisins, fruit juice, soda (not sugar-free) or hard sweets like toffees, are good for this purpose. All of these should be taken in small amounts.

Avoid unhealthy fats
Beware the hidden fats in things like sauces, stews, fried foods and pastries. Get into a habit of using low-fat or fat-free dairy products and vegetable oil spray rather than butter or margarine.

Manage your alcohol intake
One glass of wine or one beer a day shouldn’t do much harm, but remember that alcohol is generally high in sugar content and that having one too many can play havoc with your blood-glucose levels. A tot of whiskey is probably the best as it contains no sugar. Before you have any alcoholic drinks, you should speak to your doctor.

Eat lots of fresh fruit and vegetables
When cooking vegetables, bake them and sprinkle them with spices, vinegar, garlic or lemon juice (try to use less salt). These add almost no fat or kilojoules to the meal. Pears and apples are both good fruits to choose, as they have a lower glycaemic index (GI) than, for example, bananas and watermelon.

Pay attention to your fibre intake

Substitute refined carbohydrates such as white bread with seeded brown bread and other fibre-rich carbohydrates (e.g. sweet potatoes, beans or wholegrain cereal). Stay away from fried starches (e.g. potato chips and doughnuts) and highly sweetened foods (e.g. cake, rusks, sweets, cookies).

Stay informed

Knowing as much as possible is your best defence against diabetes. Find out how your body uses food and what role insulin plays in this process.

Watch out for your eyes

Diabetes is the leading cause of blindness in people between 25 – 74. Diabetic retinopathy is a disease affecting the blood vessels in the retina (the back layer of the eye). Have regular eye tests and stick to your medication, diet and exercise routine.

Don’t leave home without it

If you have type 1 diabetes and are insulin dependent, you need to have insulin injections with you at all times – even if you're just going down the road to buy a newspaper. You also need to show friends and family how to inject you if you should become unable to do it yourself. Always have spare supplies if you're travelling.

Wear proper identification
Wearing a MedicAlert bracelet (www.medicalert.org.au) is essential for all diabetics – it could save your life if you're in an accident of some sort or if you go into a diabetic coma.

Check in with your GP regularly

See the doctor frequently so that your condition can be monitored regularly. There's no point in taking chances with your health. You need to be on the lookout for any worsening symptoms that could point to hypertension, heart problems or circulatory disorders.

Keep testing your blood glucose

Invest in a blood-glucose monitor, a test strip and a lancing device. Use it regularly and you will always know how your body is coping. In this way you can always adjust your diet or your medication (with your doctor’s permission of course) before things get critical. In the case of diabetes, prevention is always better than crisis management, as it prevents complications on the long run.

Visit your dentist

Have your teeth checked regularly. Diabetes can compromise your immune system, which fights off viruses and bacteria. Your mouth is a haven for bacteria and hence your teeth are at risk if you are diabetic.

Learn to use the glycaemic index

The glycaemic index (GI) involves a ranking of foods based on their immediate effect on blood-glucose levels. Foods with a low GI (“slow-release”) don't overstimulate the pancreas to produce too much insulin. These foods include low-fat yoghurt, cereals, whole-wheat bread, fruit and vegetables and should be included in your diet regularly. Keep these in mind constantly.

Go for your influenza vaccination
 
Many diabetics are very susceptible to viral infections, so have those flu shots before the winter sets in. Immunisations against other infections doing the rounds are also advised. Don’t ignore that nagging cold that won’t go away – take it to the doctor.

Manage your stress

High stress levels can cause hyperglycaemia (high blood sugar). A healthy diet and regular exercise can help to control this, but it might be wise to see a therapist and do some yoga classes in addition to this. Learn some de-stressing techniques.

Take charge of your condition

Don’t forget that you are dealing with a potentially dangerous disease here. Take your medication as instructed and don’t skip meals or eat the wrong type of foods. By sticking to these things daily, you can control the disease instead of letting it control you.

Listen to your body

Learn to read the signs of dangerous blood sugar fluctuations – these include excessive thirst, frequent urination, extreme hunger, weight loss, inexplicable moodiness, weakness and fatigue, nausea (type 1 diabetes) and in the case of type 2, all of the previous symptoms, as well as skin, gum and bladder infections, blurred vision, itching and tingling in the hands and feet.

Quit smoking

Smoking generally increases your blood pressure. If you're diabetic, this could mean long-term circulatory problems could become more likely. Take steps to quit, however difficult it might be.
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