Diabetes Care for Seniors at Home

Diabetes in an older parent or spouse is mostly managed in the ordinary hours of the day. It comes down to breakfast, pills taken on time and someone looking at their feet. This guide covers what's different about diabetes later in life, the daily habits that help at home and the signs that mean it's time to call the doctor or 911.

How common is diabetes in older adults?

Very common. The CDC's National Diabetes Statistics Report estimates that 40.1 million people in the United States had diabetes in 2023, diagnosed or not. It also counts 31.3 million people aged 65 or older with prediabetes, which is 52.1% of that age group.

The National Institute on Aging (NIA) notes that type 2, the most common form, occurs most often in middle-aged and older adults.

How does diabetes show up differently in older adults?

The NIA lists feeling tired, more hunger or thirst, losing weight without trying, urinating often, numbness or tingling in the hands or feet, blurred vision and slow-healing cuts. With type 2, symptoms often develop slowly and can go unnoticed for a long time.

The NIA also points out that older adults sometimes write these symptoms off as "just getting old." If your mom is always tired, always thirsty and up several times a night to use the bathroom, mention it to her doctor.

A few other things set diabetes apart later in life:

Memory and mood. The NIA says older adults with diabetes are at higher risk of depression and cognitive impairment than people their age without it. Either one can make daily self-care harder. If your parent also has memory loss, our guide to dementia care at home covers routines that help.
More medicines. Many people also take medicines for blood pressure and cholesterol, which makes a pill schedule easy to get wrong.
Low blood sugar is riskier. More on that below.

What are the signs of low blood sugar in seniors?

Low blood sugar (hypoglycemia) is blood glucose below 70 mg/dL, according to the CDC. Below 54 mg/dL is considered severe.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the CDC list these common signs:

Shaky or jittery
Hungry
Tired, dizzy or lightheaded
Confused or irritable
Pounding heart or headache
Sweating

The American Diabetes Association (ADA) adds nausea, blurred vision and trouble with coordination. Very low blood sugar can cause someone to pass out or have a seizure.

Lows can also happen during sleep. The NIDDK says to watch for crying out or nightmares, sweating enough to dampen pajamas or sheets and waking up tired, irritable or confused.

Why is low blood sugar riskier for older adults?

The NIDDK names people 65 or older as being at higher risk. Lows are most likely in people who take insulin or certain pills that lower blood sugar (sulfonylureas and meglitinides). Skipped meals, more activity than usual, alcohol without food and illness can all bring one on.

Repeated lows can lead to "hypoglycemia unawareness," where a person doesn't notice symptoms until blood sugar is already very low. The ADA says a continuous glucose monitor with alarms can help, so ask the doctor whether one makes sense.

There's also the fall risk. The ADA notes that low blood sugar raises the risk of falls in older adults. That's one reason preventing falls at home matters so much with diabetes.

What to do when blood sugar drops

The ADA and NIDDK both describe the "15-15 rule." Check blood sugar. If it's low, have 15 grams of fast-acting carbohydrate, wait 15 minutes and check again. Repeat if it's still below 70 mg/dL. Once it's back up, have a snack with protein and carbohydrate so it doesn't drop again.

The ADA gives these examples of about 15 grams:

4 ounces of juice or regular (not diet) soda
1 tablespoon of sugar, honey or corn syrup
Glucose tablets or a tube of glucose gel (check the label for the amount)

Keep some by the bed and in the car.

For a severe low, when the person can't safely eat or drink, the NIDDK says glucagon is the best treatment. It comes as an injection or nasal spray. Call 911 right after giving it. Ask the doctor whether your parent should have glucagon at home and have someone show the family how to use it.

Meals and regular eating

The NIA says food affects blood glucose, so it helps to learn what to eat, how much and when. A doctor or diabetes educator can give your parent a meal plan that fits their medicines.

For many older adults the harder problem is getting meals eaten at all. Appetite drops and cooking gets tiring. For someone on insulin or a sulfonylurea, a skipped meal can lead to a low.

Things that help at home:

Regular times. Meals at about the same time each day, matched to the medicine schedule the doctor set.
Easy options ready. Pre-portioned meals in the fridge mean a tired afternoon doesn't turn into no lunch.
Water close by. Unusual thirst is worth mentioning to the doctor.
Notes on appetite. If your parent is eating much less than usual, tell the doctor. Medicines may need to change.

The NIA says walking and other daily exercise can also improve glucose levels. Ask the doctor what's safe.

Why are daily foot checks so important?

According to the CDC, about half of all people with diabetes develop some form of nerve damage. When feet lose feeling, a blister or small cut can go unnoticed until it's infected.

The CDC recommends checking feet every day for:

Cuts, sores or blisters
Redness or swelling
Corns or calluses
Changes to the skin or nails

Many older adults can't see the bottoms of their feet. The NIA suggests asking someone else to check, which a family member or caregiver can do at bath time.

Other foot habits from the CDC:

Wash feet daily in warm (not hot) water, without soaking, and dry them well.
Use lotion on the tops and bottoms of the feet but not between the toes.
Wear shoes and socks indoors and out.
Don't use over-the-counter corn or callus removers.

The CDC recommends a foot check at every doctor visit and a podiatrist exam at least once a year, more often with nerve damage. Call the doctor right away about any sore that isn't healing, changes in color or temperature, new numbness, tingling or burning pain.

Medication reminders

The NIA says to take diabetes medicines as prescribed even when feeling fine, and to tell the doctor about side effects, trouble keeping track of the schedule or trouble affording them.

Practical setups that work at home:

A weekly pill organizer filled by the person or a family member, or blister packs from the pharmacy.
A written schedule on the fridge that lists each medicine and when it's due.
A simple log of doses taken and blood sugar readings to bring to appointments.

If readings are running high or low, call the doctor rather than changing doses on your own.

What should you do on sick days?

The CDC explains that hormones the body releases to fight illness can raise blood sugar, and a sick person may not eat or drink as much as usual.

The CDC's sick day guidance:

Keep taking diabetes medicines as usual unless the doctor says otherwise.
Check blood sugar every 4 hours and write down the results.
Drink plenty of water.
If they can't eat regular meals, aim for about 50 grams of carbohydrate every 4 hours (for example, 1½ cups of fruit juice or unsweetened applesauce).

Ask the doctor for a written sick day plan ahead of time.

When should you call the doctor or 911?

The CDC says to go to the emergency room if your parent:

Has trouble breathing
Has ketones in their urine
Can't keep liquids down for more than 4 hours, or food for more than 24 hours
Loses 5 pounds or more during the illness
Has blood sugar below 60 mg/dL
Has vomiting or severe diarrhea for more than 6 hours
Has a temperature over 101°F for 24 hours

Call 911 for a person who has passed out, had a seizure or can't safely swallow during a low, and call right after giving glucagon.

Call the doctor for lows that keep happening, readings that stay high, a foot sore that isn't healing, new confusion or a big change in eating.

How in-home care helps with diabetes

Most of what keeps diabetes steady happens between doctor visits. An in-home caregiver can help by preparing simple meals on a regular schedule that follows the doctor's dietary instructions, reminding your parent when it's time for medicine, helping them get to their containers and noting any missed doses. During bathing and dressing a caregiver can look at feet and tell the family about redness, blisters or sores. Caregivers also report changes, like a drop in appetite or new confusion, and can drive your parent to appointments.

Caregivers don't give insulin or other medication, choose doses or read blood sugar results. When care calls for clinical work, a licensed nurse can be arranged.

Tale Circle Care serves families across metro Atlanta, from Marietta to Peachtree City and Cumming. You can see all our service areas. If you're wondering whether a parent with diabetes is managing alone, our list of signs a parent needs help at home is a good starting point, or call Taly at (346) 278-3018.

For free help finding local programs, the Atlanta Regional Commission's Empowerline offers free consultations and wellness workshops at (404) 463-3333.

Common questions

Can a caregiver check blood sugar for my parent?

Tale Circle Care caregivers don't read or act on clinical results. They can remind your parent to check, help them get their supplies and tell you or the doctor about concerns. Ask the doctor or a nurse about who should do testing.

Does diabetes raise the risk of other problems?

Yes. The NIA says poorly managed diabetes can damage the eyes, kidneys, nerves, feet and heart over time. Many people with diabetes also take medicines for high blood pressure, and heart failure care at home covers many of the same habits. The NIA recommends yearly eye exams and kidney tests.

What vaccines matter for older adults with diabetes?

The NIA recommends a yearly flu shot and the pneumonia vaccine for people over 65. Ask the doctor which others are due.

Sources

This guide is general information for families, not medical advice. Ask the person's doctor about their care, and call 911 in an emergency.