Managing Diabetes in Your Elderly Parent

A practical guide to blood sugar management, medications, diet, and preventing complications

Nearly 1 in 4 adults over 65 has diabetes—about 15 million people. If your aging parent has diabetes, you play a critical role in helping them manage it, especially as age-related challenges like cognitive decline, vision problems, and dexterity issues make self-management harder.

27%
of seniors 65+ have diabetes
50%
are undiagnosed or prediabetic
#1
cause of kidney failure

Understanding Blood Sugar Targets

Blood sugar management in elderly adults is often less aggressive than in younger people. Too-tight control increases the risk of dangerous hypoglycemia (low blood sugar), which can cause falls, confusion, and even death in seniors.

Measurement Healthy Senior Target Frail/Complex Senior
Fasting blood sugar 90-130 mg/dL 100-180 mg/dL
Before meals 90-130 mg/dL 100-180 mg/dL
2 hours after meals Under 180 mg/dL Under 200 mg/dL
A1C (3-month average) 7.0-7.5% 7.5-8.5%
Individualized Targets: Talk with your parent's doctor about appropriate targets for their specific situation. Factors like life expectancy, other health conditions, cognitive status, and risk of hypoglycemia all affect what targets make sense.

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Recognizing Blood Sugar Problems

Low Blood Sugar (Hypoglycemia)

Below 70 mg/dL – Can be life-threatening

  • Shakiness, trembling
  • Sweating, clamminess
  • Confusion, irritability
  • Dizziness, lightheadedness
  • Hunger
  • Fast heartbeat
  • Headache
  • Seizures (severe)

High Blood Sugar (Hyperglycemia)

Above 180 mg/dL – Causes long-term damage

  • Frequent urination
  • Excessive thirst
  • Blurred vision
  • Fatigue
  • Headache
  • Slow-healing wounds
  • Fruity breath odor
  • Nausea (severe)
Hypoglycemia Unawareness: Many seniors lose the ability to feel low blood sugar symptoms—a condition called hypoglycemia unawareness. They may not feel shaky or sweaty before confusion sets in. This makes regular monitoring critical and may warrant looser blood sugar targets.

Treating Low Blood Sugar

Follow the "Rule of 15":

1

Give 15 grams of fast-acting carbs

4 glucose tablets, 4 oz juice or regular soda, 1 tablespoon honey or sugar, or glucose gel

2

Wait 15 minutes

Recheck blood sugar after 15 minutes

3

Repeat if still low

If still under 70, give another 15 grams and wait 15 more minutes

4

Follow with a snack

Once blood sugar is above 70, eat a small snack with protein if next meal is more than an hour away

If Unconscious or Unable to Swallow: Never put food or drink in an unconscious person's mouth. Use glucagon (injectable or nasal spray) if available and call 911. This is why caregivers should have glucagon on hand and know how to use it.

Diabetes Medications

Understanding your parent's diabetes medications helps you support proper management and watch for side effects:

Metformin (Glucophage)

First-Line Oral Medication

Usually the first medication prescribed for Type 2 diabetes.

Sulfonylureas (Glipizide, Glyburide)

Oral – Stimulates Insulin Release

Older class of diabetes medications, still commonly used.

SGLT2 Inhibitors (Jardiance, Farxiga)

Oral – Removes Sugar Through Urine

Newer medications with heart and kidney benefits.

GLP-1 Receptor Agonists (Ozempic, Trulicity)

Injectable – Weekly

Weekly injections that help with blood sugar and weight.

Insulin

Injectable – Various Types

May be needed as Type 2 diabetes progresses.

Medication Simplification: For elderly patients, doctors often try to simplify regimens—fewer medications, fewer daily doses, lower hypoglycemia risk. Talk to the doctor if the current regimen is complex or causing problems.

Blood Sugar Monitoring

Regular monitoring is essential, but the frequency depends on your parent's medications and stability:

Traditional Finger-Stick Monitors

  • Most affordable option
  • Test strips can be expensive
  • Requires dexterity and vision
  • Provides a snapshot in time
  • May need help if hands are arthritic

Continuous Glucose Monitors (CGMs)

  • Sensor worn on arm or abdomen
  • Readings every 5 minutes
  • Shows trends and patterns
  • Alerts for highs and lows
  • Can share data with caregivers
  • Medicare covers with certain criteria
CGM for Remote Monitoring: Continuous glucose monitors like FreeStyle Libre or Dexterity can share real-time data with caregivers. If you don't live with your parent, this lets you see their blood sugar levels and get alerts about dangerous lows—even from across the country.

Diet and Nutrition

A diabetes-friendly diet doesn't have to be restrictive. Focus on balance and consistency:

✓ Emphasize

  • Non-starchy vegetables
  • Lean proteins
  • Whole grains (in moderation)
  • Healthy fats (olive oil, nuts)
  • Berries, cherries
  • Beans, legumes

⚠ Limit

  • White bread, rice, pasta
  • Potatoes
  • Fruit juice
  • Processed meats
  • Fried foods
  • Alcohol

✗ Avoid/Minimize

  • Sugary drinks (soda, sweet tea)
  • Candy, desserts
  • Pastries, donuts
  • Sweetened cereals
  • High-sugar condiments

Practical Eating Tips for Seniors

1

Consistent meal timing

Eating at regular times helps stabilize blood sugar, especially for those on insulin or sulfonylureas.

2

Don't skip meals

Skipping meals while taking diabetes medication can cause dangerous hypoglycemia.

3

Pair carbs with protein

Adding protein to carbohydrates slows sugar absorption and prevents spikes.

4

Stay hydrated

High blood sugar causes dehydration. Encourage water throughout the day.

5

Read nutrition labels

Focus on total carbohydrates, not just sugar. Carbs from any source affect blood sugar.

Balance Quality of Life: For frail elderly patients with limited life expectancy, strict dietary restrictions may reduce quality of life without significant benefit. Discuss with their healthcare team what dietary approach makes sense for your parent's situation.

Preventing Complications

Diabetes damages blood vessels over time, affecting nearly every organ system. Regular screening and prevention are crucial:

👁️

Eye Disease (Retinopathy)

Leading cause of blindness in adults. Annual dilated eye exams are essential. Early treatment can prevent vision loss.

🦶

Foot Problems

Nerve damage and poor circulation can lead to ulcers and amputation. Check feet daily for cuts, blisters, or color changes. See a podiatrist regularly.

🫀

Heart Disease

People with diabetes are 2-4x more likely to have heart disease. Control blood pressure, cholesterol, and blood sugar. Most should be on a statin.

🧠

Kidney Disease (Nephropathy)

Diabetes is the #1 cause of kidney failure. Annual urine test for protein and blood tests for kidney function. SGLT2 inhibitors offer protection.

🦷

Dental Problems

Higher risk of gum disease and infections. Regular dental visits are important. Poor dental health can make blood sugar harder to control.

Daily Foot Care

Foot problems are one of the most preventable—and most serious—diabetes complications. Establish a daily routine:

Inspect feet daily

Look for cuts, blisters, redness, swelling, or nail problems. Use a mirror for the bottom or have someone help.

Wash and dry carefully

Wash feet daily in lukewarm water. Dry thoroughly, especially between toes where infections start.

Moisturize (but not between toes)

Apply lotion to prevent cracking, but not between toes where it can promote fungal infections.

Wear proper footwear

Never go barefoot. Wear well-fitting shoes and seamless socks. Medicare covers diabetic shoes.

See a podiatrist

Regular foot exams and professional nail care, especially if nails are thick or vision is poor.

Track Blood Sugar & Medications

Our daily care logs include medication tracking, blood sugar logs, and symptom monitoring all in one place.

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When to Call the Doctor

Seek Immediate Medical Attention For: