Elders and Diabetes: Caring for the Most Vulnerable

Each November, communities bring awareness to diabetes and its impact on Americans’ health and well-being.   Diabetes is a devastating disease to more than 30 million Americans, with over 60 million more at risk for developing this chronic disease.

Individuals with diabetes often experience other health complications like heart attacks and stroke, problems with eyesight, tingling or pain in the feet or legs, kidney disease and other conditions.  Healthcare costs associated with treating diabetes topped over $327 billion in 2017. Medical expenditures averaged 2.3 times higher than those without diabetes.

These statistics may catch your attention, but there is a very vulnerable population of individuals with diabetes-the oldest and frailest- whom don’t get the attention they deserve. Older adults over the age of 65 are six times more likely to develop diabetes and often experience severe complications.

Diabetes Across the Lifespan

High blood glucose (sugar) levels over months or years lead to a diabetes diagnosis. Genetics, family history, ethnicity, and lifestyle factors all contribute to the onset of Type 1 or 2 diabetes. Children and adults can typically manage blood glucose levels through medication, diet and exercise. But for the chronically ill or those advanced in age, keeping blood glucose within a healthy range is much more difficult.

Older Adults and Health Complications

While high blood glucose has serious health consequences, low blood glucose or hypoglycemia is extremely dangerous for frail, older adults. Chronic low blood glucose can lead to impaired thinking, depression, increased risk of falls, persistent pain and hospitalizations or readmissions.  Missing meals is the first cause of hypoglycemia in older adults. Not eating enough and certain medications used to treat diabetes also contribute.


Older adults who experience chronic low blood glucose are at much greater risk for impaired thinking, depression, increased risk of falls, persistent pain and hospitalizations or readmissions.


Warning Signs of Hypoglycemia

Hypoglycemia is not well understood nor respected for its seriousness.  It’s important that caregivers know the warning signs and take steps to prevent low blood glucose.  Some elders may feel shaky, tired, irritable or confused as blood glucose drops to low levels, and symptoms can happen very quickly.  Symptoms may be hard to distinguish from normal behaviors because they are more common, in general, with older adults. Caregivers can be proactive in preventing hypoglycemia by following some simple guidelines.


How can Caregivers Help?

Follow these tips for better management of blood glucose and less diabetes complications:

  • ·Educate elders not to skip meals – if a full meal isn’t appealing, have a satisfying snack that includes carbohydrates and lean protein. Skipping meals is the number one cause of hypoglycemia. Keep healthy choices (fresh or dried fruit, unsalted nuts, granola bars, peanut butter crackers) in sight and in reach.

  • Remind elders to eat meals and snacks on a regular schedule.  Plan on 3 small meals and 1-2 snacks spaced evenly during the day. if a caregiver isn’t available during each meal period, they can still prepare a healthful snack or lite meal that the elder can easily access when needed.

  • Encourage elders to eat about the same amount of carbohydrates at the same time each day.  Older adults typically need 2-3 carb servings at each meal and 1-2 at snacks.

  • Learn about an elder’s favorite foods and incorporate into to the meal plan.  While chocolate chip cookies don’t offer a lot of nutrition, they can still fit into a diabetic menu, in the right amount at the right time. Restricting food choice causes elders to feel deprived, with a greater negative impact than eating the cookie. Quality of life is the ultimate goal.

  • Stay hydrated – offer plenty of low-sugar beverages like water, coffee or tea or sugar-free drinks throughout the day. Milk and fruit juice are also good choices but do contain carbs.

  •  Monitor medication.  It is critical that elders take all medication as directed. 

Diabetes-Friendly Foods

Nearly all foods can fit into a diabetic diet, but some are better choices than others.  Meals and snacks should include plenty of non-starchy vegetables like carrots, green beans, peppers or leafy greens.

Add lean protein from chicken, fish, lean meat and plant sources in moderate amounts -too much protein puts extra stress on the kidneys. Choose starchy vegetables like potatoes, corn or peas, whole grains, low-fat dairy and fruit for energy from carbs and other key nutrients.

Need to satisfy a sweet tooth? Small servings of gelatin, pudding, cookies or frozen yogurt can all fit.  Just remember SUGAR FREE doesn’t mean CARB FREE.  Read labels closely.                                                                                                                                                  

Food Insecurity

Financial concerns can cause elders to skip meals or skimp on healthful food.  Food insecurity is a real concern to those with diabetes when the cost of medication competes with money for food. Resources like the Supplemental Nutrition Assistance Program (SNAP), farmers market vouchers, community food banks and congregate meals may be available in your area.  Contact the local Agency on Aging to learn more.

Knowing More

We can all become advocates for those in our lives with diabetes.  Knowing more about nutrition and mealtime management of diabetes will help lessen complications, allow for better glucose control and improve overall quality of life for those in our care.



American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. 1 May 2018. Accessed 16 Nov. 2018. http://care.diabetesjournals.org/content/41/5/917.full-text.pdf

Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. CDC. Assessed 14 Nov. 2018. http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf

Endocrine Society. Highs & Lows: Reevaluating Hypoglycemia in Elderly Diabetes Patients. No Date. Accessed 11 Nov. 2018. https://endocrinenews.endocrine.org/highs-lows-reevaluating-hypoglycemia-elderly-diabetes-patients.

USDA. Food and Nutrition Service. Supplemental Nutrition Assistance Program: SNAP Special Rules for Elderly or Disabled. Updated 1 Oct. 2018. Assessed 14 Nov. 2018. https://www.fns.usda.gov/snap/snap-special-rules-elderly-or-disabled.


Chef Beth Scholer, CC, CDM, CFPP, is a food scientist, culinary instructor, author and founder of Caregivers Kitchen. She is passionate about empowering caregivers to make positive nutritional changes and mealtime meaningful for those in their care.   She can be reached at chefbeth@caregiverskitchen.net.