June 08th, 2022

Turning the tide on diabetes
 More than one in four Kwis have diabetes, and it’s estimated that another 100,000 
are undiagnosed.  Diabetes New Zealand represents and supports people with diabetes.
They have branches across New Zealand with staff and volunteers who help 
people to live well with diabetes
 
From: Aged Care New Zealand, Issue 02 2021

Our vision is that the tide will be turned on diabetes, a health condition that threatens to overwhelm New Zealand’s health system both now and in the future.  Our mission is to ensure that all people living in New Zealand who are affected by, or at risk of, diabetes have access to the appropriate tools, information and support essential for their health and wellbeing.
 
People aged 40 years or over are at increased risk of developing Type 2 diabetes, but many problems with diabetes can be prevented with early diagnosis and good management.  What’s more, you can support older people in the community to take action that may prevent them from ever getting diabetes.
 
Diet, exercise, and looking after themselves both physically and emotionally, all contribute to managing or preventing diabetes. And these tips can be applied to carers too. 
 
You are what you eat
 
Older people with diabetes need to eat a balanced diet to help manage their blood glucose levels as well as address any other dietary issues they may have.  While managing excess weight is key earlier in life, for those over 70 a little excess weight can actually reduce the risk of poor health.
 
Malnutrition and becoming underweight is an increasing issue for older people.  In the case of an older person with diabetes who is also malnourished, they will need both their diabetes medication and their diet reviewed by appropriate members of their health team.
 
With or without diabetes, as one gets older one should drink plenty of water and maintain a good diet of breakfast, lunch and dinner every day.
 
Unless otherwise advised by their health professional, older people should be eating meals that:

• avoid fruit juice and other sweet drinks
• are based around the Diabetes New Zealand healthy plate model (available on the website)
• include some carbohydrate food at each meal, but not too much
• choose low sugar, low saturated fat, low salt and high fibre food

 
It is important to remember that diet for older people with diabetes will often be indivdualised and should always be under the supervision of their health team.
 
Get physical 
 
Exercise is especially important for people with diabetes as exercise helps insulin lower blood glucose levels.
 
For older people, regular weight bearing and muscle strenghtening exercise can also help prevent bone loss and, by enhancing balance and flexibility, reduce the likelihood of falling and breaking a bone.
 
Walking is an ideal form of basic physical activity.  Firstly, it’s low to medium intensity - people can be encouraged to walk briskly so they elevate their heart rate but aren’t gasping for air.  It is easy on the joints, it promotes good blood flow, can be done on a whim at any time of day or night, its free; and there is no complicated equipment required.
 
Active walking promotes good blood flow by increasing heart rate without making it pound out of the chest, and as they become more accomplished walkers they can make it more challlenging.
 
The first and most important step is to get some good shoes to walk in, comfortable and with plenty of padding in the innersole.  Support those with diabetes-related foot complications to talk with their podiatrist about shoe and sock recommendations.  Although walking is easy, it is still a physical activity and should be treated as such.  Remember to also promote stretching after walks, ensure good water intake and encourage getting some rest.

Best foot forward
 
Foot care is crucial for people with diabetes, and problems with feet in old age are one of the main reasons members of your community might struggle with exercise.
 
Fortunately, giving feet some extra care can help a lot.
 

• Wash and carefully dry feet every day. Take special care to gently dry between the toes
• Moisturise feet very lightly every day, but not between toes.
• Ensure they are wearing well fitting and sensible shoes. Broad and deep sports shoes are often a good option.
• Look at feet every day to check they look healthy and normal.
• Check shoes for foreign objects before putting them on.
• Ensure GP’s undertake regular foot checks

 
For those with diabetes, high blood sugar can cause neuropathy (nerve damage) and poor blood circulation over time.  It also raises infection risks, as bacteria thrive on sugar.  If someone you support has nerve damage or poor cirulation in their feet you will need to take additional precautions; see www.diabetes.org.nz/complications-feet. Get them to see their doctor immediately if they get any sort of cut on their feet.
 
Love your skin and it will love you
 
Health professionals believe people with diabetes can reduce their chances of skin problems by taking good care of their skin and managing their diabetes properly.

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Here are their top tips
 

• Keep blood glucose levels in as healthy a range as possible. When blood glucose levels are high there is more likelihood of dry skin and an increased risk of infection.
• Keep skin clean and dry.  Use talcum powder or anti-chafing cream in areas where skin touches skin, such as armpits and groin.
• Protect skin.  Wear gloves when using cleaners, solvents and other household detergents.
• Avoid very hot baths and showers.  Don’t use bubble baths.  Moisturising soaps may help.  Afterward, use a light moisturising skin cream, except between the toes.
• Where possible prevent dry skin.  Moisturise skin to keep it supple and prevent chapping especially in cold or windy weather.
• Treat cuts right away.  Wash minor cuts with soap and water.  Do not use alcohol or iodine to clean skin because they are too harsh.  Only use an antibiotic cream or ointment if their doctor says it’s okay.  Cover minor cuts with sterile gauze.
• During cold, dry months, keep the living environment more humid.
• Use mild shampoos and unscented soaps.  Do not use feminine hygiene spays.
• Take good care of feet, and
• If someone experiences a major cut, burns or infection, they should receive professional medical attention immediately

 
Emotional wellbeing also needs attention
 
The past year has been frightening and stressful for everyone.  For those who are especially vulnerable to COVID-19, including those who are older and/or with pre-existing medical conditions such as diabetes, it has been more stressful for most.
 
Diabetes New Zealand undertook new research in October that revealed distress related to COVID-19 had been even more acute for the quarter of a million people living with Diabetes New Zealand.
 
The good news is that the research also showed that practicing self-compassion can help reduce stress, which in turn can help with better diabetes management, improve overall health and wellbeing and also mental health.
 
The simplest way to assist those you support to manifest self-compassion in daily life is to discover how they already care for themselves, and then aid them to do these things when life becomes difficult.
 
Physical – soften the body
How would they care for themselves physically?  Exercise, massage, warm bath, a cup of tea?  Make time for these when things get tough.
 
Mental – reduce agitation
How do they care for their minds, especially when they’re under stress?  Suggest meditating, reading an inspiring book, or something you know they find reassuring.
 
Emotional – support them to soothe and comfort themselves
How do you care for yourself? Pay attention to how people in your care do it for themselves.  For example, they might enjoy being outdoors, writing a journal, or cooking.
 
Relationships – connect with others
How or when do they relate to others in a way that brings them genuine happiness? Perhaps they could meet with friends, send a birthday card, play a game with the grandchildren
 
Spiritual – respecting and embracing their values
What do they do to care for themselves spiritually? Maybe they pray, walk in the bush or on a beach, or take pleasure in helping others.
 
Finding the things that help those you support to feel well helps you to support them better.  And who knows – it might help you to care better for yourself too.
 
Diabetes New Zealand           Phone: 0800 342 238   Website. www.diabetes.org.nz
 
 
Reference:
 
Aged Care NZ Issue 02 2021