If diet, exercise, and oral medications do not adequately control the diabetes, your physician will likely suggest insulin treatment. Insulin may also be the initial treatment if your blood glucose levels are very high. Many types of insulin are available. Usually the initial dose of insulin is low (about 15 units of an intermediate-acting insulin), given as a once-a-day injection before breakfast. Your health care providers will show you how to monitor yourself and change the dosage of insulin as needed.

The greatest risk of insulin therapy is lowering the level of blood glucose too much, especially in frail older adults. Older adults often do not show early symptoms of low blood glucose. Because of this, blood glucose levels are initially checked on an empty stomach, after eating, and at bedtime to be sure that the level does not drop suddenly in any of these situations. People with diabetes and their caregivers should learn how to use a simple machine to check blood glucose. Blood glucose should be checked at least every week, even if the levels have stabilized, or more frequently if medications are being changed or you feel sick.

People with diabetes need to keep foods high in glucose (eg, honey and fruit juice) handy in case of an episode of dangerously low blood glucose. If episodes of low blood glucose are frequent or severe, the management plan, including medications, should be reevaluated. In some cases, all that is needed is a better understanding of what needs to be done to control blood glucose levels. Some people may need more frequent contact with their healthcare providers or even referral to specialists in diabetes care. Sometimes, other factors make diabetes management at home difficult, such as disability or lack of caregiver support.

Intensive management of all conditions associated with diabetes may not be practical or reasonable for everyone. For some older adults with diabetes, aggressive management may not improve the situation and may even result in harm. This is especially true for people who have other severe illnesses, disabilities, or a limited life expectancy. In these situations, yor health care provider will help you and your caregivers choose the appropriate level of treatment. Management must be designed to fit your situation, taking into consideration your preferences and quality of life.

Your role in treatment

Ideally, you (and your caregivers) can manage your diabetes day-to-day on your own by understanding how the disease works and by learning what needs to be done and how to do it. Ask your health care provider as many questions as often as needed until you feel comfortable that you understand what you need to do. Monitoring your blood glucose levels is extremely important, and your health care provider will show you how to use the tools to do so. You should keep track of your blood glucose results, noting the time of day and when you last ate and took medication, and bring this record with you to each visit with your health care provider. You may want to ask your health care provider to check your technique periodically to make sure you are managing your blood glucose correctly.

It is also important to know the consequences of low and high blood glucose, including triggers, prevention, symptoms, monitoring, and treatment, as well as situations when you should notify your health care provider. You also need to know the reason for every drug you are taking, how to take it, and its common side effects. In addition, you should learn about proper foot care and the risk factors for foot ulcers and amputation.

Your health care provider will likely provide you with some written information about diabetes that you can use for reference. If you need additional training, you may visit a diabetes educator for one-on-one counseling or go to group training classes. Training programs in diabetes self-management are covered under Medicare Part B and can be repeated every year.

Caregivers should also receive training and become involved in your diabetes self-management program. Caregivers may need to take over the self-management program if the older person with diabetes begins to have mental difficulties or becomes significantly disabled.

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