Uncontrolled diabetes and diet in advanced elderly. Any advice?

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Uncontrolled diabetes and diet in advanced elderly. Any advice?

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My mom is 91 and type 2 diabetic plus heart and kidney failure. I care for her and her blood sugar is not controlled well recently since she refuses insulin and the therapeutic dosages of pills have bad side effects like severe constipation…lately her numbers are 300 fasting in AM vs 180 normally …she is constantly carb snacking even after big meals ...emotional eating/carb cravings …etc…. I know at her age she should eat what she wants since death looms but she has wounds now that aren’t healing and I am trying to avoid more suffering and hospitalizations for her before she dies one day. It’s a tough balancing act and I feel like a bad cop… should I let a 91 yr old eat what they want and have blood sugars go into 600s and hasten her death or monitor/ hide foods like I’m doing daily to keep her out of hospital etc ie carbs she loves…..I still give her pasta on Sundays and sandwiches and 1/2 bagel for bfast so not denying just limiting

Care Decisions Diabetes Diet & Nutrition Refusing Care

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Hi! your post doesn’t suggest that Mother has dementia issues or is legally incompetent. One reasonable option is for you to ask her what she wants. Does she want to eat what she likes and pass sooner, or does she want you to control her diet so that she lives as long as possible? There is no reason why it should not be her choice. If she chooses the ‘eat what I want’ option, you can then consider Hospice and your own future, without feeling that you are guilty about the results of her choice. Her suffering may also be less and quicker, and with Hospice, hospitalisations are less likely. A Hospice assessment might give both of you more information about this, and it doesn't commit you to take it up.

Let her make her own decision!

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I completely agree with you. The elderly must be involved in the decisions concerning their lives and lifestyles. There is only one caution that I would add to your suggestion. That is that ignoring one's diabetes does not only hasten the end of life. There are other issues that are also part of uncontrolled diabetes. In my mother's case there were circulatory problems and vision problems that may have been worsened by her decision to partially ignore medical advice. She ate candy and other things as she desired. She suffered the consequences. However, she died of renal failure--at 96. Mostly, she had a good life.

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This is hard! I would really struggle with my mom pulling something like this. I'm surprised that your mom doesn't have some level of dementia, given her age and her conditions. How long has she had diabetes and been refusing insulin? If she is still cognizant, I would arrange a hospice eval. With wounds that aren't healing, she's in for some tough times.

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That's kind of harsh. Not every senior in their 90s is mentally damaged even with health issues 🙂

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She is in denial that the diabetes will create illness in her…she is done with this life of pills illness etc but when she gets sick or gets wounds she says” why is this happening to me” “ call the dr but I dint want to go to hospital”… sge knows she wants to eat and doesn’t want shots but also doesn’t want to be sick
Ie just wants to die wo suffering in her sleep…hospice is est life less than 6 months ..she doesn’t qualify yet..I would love to have here at all sge wants at her age but sadly it will cause more suffering and sge doesn’t reakuze that part ie moderate dementia

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You need to check with another hospice. Like others have said, the 6 month rule isn't like it used to be, my mother-in-law has been on hospice for over 2 years. She has lung cancer. They help out so much! They manage all of her meds, and a lot of times she will listen to them and not us, even when we tell her the exact same thing.

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Is she on hospice? I understand the "no hospital" sentiment-- hospice will get her a hospice nurse to manage her emergencies and keep her comfortable.

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So re-reading, I see you say she's not hospice eligible. I would try calling a different hospice organization. That "6 month rule" is not as written in stone as it used to be.

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Posts such as this make me shudder. While I agree that a competent adult should absolutely get a say in their health, there is a side to this that also needs to be addressed, and that's the issue that you, Mhill, might inadvertently be held somewhat responsible for mom's bad decisions.

Mhill, does mom live with you and are you considered her primary caregiver? What brought me into this forum was when my mom ended up with a viral infection and wasn't up to eating for a few days. She just wanted to sleep and get better; but when it became clear that she needed emergency care, and I brought her to the ER, I was questioned, lectured and scolded by the internist who saw her in the ER - basically accusing me of withholding food from her. Even though SHE had told him she didn't eat by HER choice, I was still in the hot seat, so to speak - because the assumption by this doctor was that if my mom was choosing not to eat, that meant she clearly wasn't in her "right" mind frame, and somehow or another *I* - as the person with whom she lived and therefore her primary caregiver - was supposed to, somehow, FORCE her to eat something. I even asked this idiot doctor "what am I supposed to do here, doc - sit on her chest and force the food down her throat?".

If your mom is going to refuse to maintain a diabetic diet to the point of her own detriment, then you should make sure she tells as much to her PCP...that this is HER doing, that you have been "encouraging" her to maintain the proper diet, you have been and are willing to continue to provide the foods that she should be eating to maintain that diet.

And definitely ask for a hospice consult. Once medical people find out that a patient is under hospice care, all of a sudden things like diet seem to not matter as much to them. My mom went into hospice, and for the first 6 weeks she actually got better, once the thought of the constant revolving door of doctor/hospital/rehab from removed from the equation. Hospice took care of her, provided the meds she needed, removed the ones that were no longer doing anything for her, and encouraged her to enjoy the time she had left. You want to have a glass of wine? Why not? A salty snack? Why not? She was happy, she was enjoying the little things that were left to her, and she passed away peacefully in no pain.

Good luck!

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See responses above thank yiu

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"2 diabetic plus heart and kidney failure" Have you actually had Hospice come in and evaluate Mom? I think the list of her illnesses is a good reason for Hospice. She is too old for a heart transplant and probably will not be put on dialysis. So, she will die from one of the 3 illnesses, As said, that 6 months is not written in stone.

Have you spoken to her doctors to see if some of her meds can be stopped. One I would suggest is if she is on a blood thinner. They cause internal bleeding. Another is Cholesterol, they effect her liver enzymes and cause cognitive decline.

IMO Mom not realizing the sores are caused by not taking her insulin, she is in some sort of cognitive decline. These sores need a Wound care Nurse taking care of them. Her sugar levels being high could cause confusion. Heart failure, not enough oxygen getting into her system and up to the brain. Kidney failure, toxins getting into her blood stream and up to the brain causing her to be "out there". She is not competent to make decisions concerning her health. She doesn't want to go to the hospital, then she needs to take her insulin.

I would get her to her doctor and get Labs done. Tell him what is going on and have him document it. Follow up with an email confirming your conversation and his recommendations.

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we go to weekly wound care and I do the daily change of dressing and cleaning of wound ..I get labs monthly ..I contact her drs almost daily ( they all know about the insulin)..I have all specialities on her care team….she has mild dementia and short term memory issues ..she wants to die at home but I explain it’s not that simple esp if you have a diabetic crisis etc …we had palliative care consult today and documented her wishes ( no tubes, etc) but we have to get her sugar under control.. I’m working on that with her but I can’t force her and yes, high blood sugars could lead to more problems that eventhough I tell her about , her fear of insulin blocks her rational mind to make a sound judgement..sge wants to due wo tubes, wo insulin,wo hospitals but doesn’t realize that is not guaranteed.

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I get labs every month..all her drs are aware she doesn’t want insulin ..,I give her diabetes meds but they aren’t as effective as insulin anymore… I’m restricting foods to get sugar down,,

…she isn’t dying but declining …she eats 3 meals per day but sleeps a lot..watches tv w me in late afternoon till 9…today we met with palliative care to include them on her care team when and if she declines further …I can’t force her to try insulin but I will continue stressing it’s importance …sge doesn’t tell me why she is so afraid of it but she has shuddered for yesrs when she heard others do insulin shots…

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I've done my own insulin shots for years. Four a day. Painless and easy.

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Chiming in to say I get the struggle. My dad didn’t have diabetes but end stage congestive heart failure made worse by his diet. His cardiologist chided him constantly to improve his food choices so he’d function and feel better. Dad had a completely sound mind, he simply wasn’t interested. As he aged his appetite for junk foods increased dramatically. It seemed that it took sharper flavors like fried food or sweets for him to enjoy foods. He’d had enough of this world after experiencing many losses of loved ones and his own health decline and just didn’t care a bit to improve his diet. My siblings and I tried for a while to encourage better choices but eventually saw it wasn’t getting us anywhere. Your mom is blessed to have you looking out for her and trying to make this better, diabetic ulcers are no joke. Hoping you find a good path forward…

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Mhil, has she ever had an insulin injection with one of the new tiny needles? They really are painless.

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I know I showed her the pen..have it in the fridge but there is so much fear about it

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As someone else has suggested above, and as I myself have learned (being in a similar position with my stubborn mother), as long as she is mentally competent it is entirely her choice, even medics cannot force anything upon her. I learned a great analogy recently from another poster; when we come to look after our parents, we almost became the parent and our parent likened to the child. However, our parents almost always still see us as their children, and many don’t like to be told what to do by us. Maybe it’s pride, dignity, or stubbornness. I know I’ve tried to help my mum, oh lord have I tried with so many multiple different issues. She won’t bathe, she won’t eat, she even refuses professional medical assistance. Mostly I don’t push though. One thing I do though is make sure her environment is spotlessly clean, she has food and drink on hand, and be prepared to help her with anything she does ask for.

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So true. My sisters and I were Mom's children right to the end. There was never a moment that we didn't know that we were never going to "parent" Mom. I suppose there are some that would go along with that role reversal, but there is no use fighting it if the parent you care for is really stubborn. With Mom, light suggestions and playing up the positives of slight changes were the best motivators. Anything that smacked of coercion was doomed to failure no matter how highly recommended. I think the hardest part of caring is accepting that as we set limits on what we might do, our parents are also setting limits on how far they will let us go. We were lucky that there were 3 of us to do hands on care and a 4th who was supportive by phone and an occasional visit. We could talk about the ideal and the real and the big gap between them. Ultimately, we agreed that the best thing we could do was to make Mom's life as pleasant as possible, not as long as possible. That meant pleasant for us as well as for her. None of us went into heroics or went far beyond our original limits. I think Mom may have been physically better if she had been willing to mind her diet and a few other things, but her attitudes and apparent enjoyment of life were best when she made most of the decisions.

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We had to install a key lock on our pantry and put a refrigerator in our laundry room and a key lock on the laundry room door when my mom lived with us. She would get up during the night and eat anything she could find that was sweet or was carbs. She craves them. Doing so pushed her blood sugar way too high.

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This comment probably not related to other comments, but will input my opinions. Don't mess around with diabetes if you already have it! If at prediabetes level, you have about ten years to avoid the 6.5 diabetic condition.

For example, I'm getting a repeat A1c lab test done today to see what my blood glucose level is for my prediabetes condition. Hopefully I will not require medication besides diet and exercise to prevent diabetes II like my mother's side had.

Your mother requires managaged blood glucose goals. Tell her doctor about the constipation to see if a referred laxative, such as Lactoluse, can be prescribed. If insulin and other meds can be restarted, please do so. What about getting professional help to cope with her fears? They are life savers but hopefully not too late.

Sounds like your mom is coming closer to death and I'm sorry to hear that.

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My A1c results was a 5.5 yesterday. Down by 0.4 and counting!

Patathome01

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My heart goes out to you.

There’s also the option of palliative care if your mom isn’t eligible for hospice yet.

A good friend of mine works as a Palliative PA and her advice is to explain to your loved ones that various decisions are “doctor’s orders” so the doctor takes the “blame” and not you.

I suggest telling your mom that a diabetic diet is doctor’s orders and then you don’t keep high carb options in the house. My dad has been a type 1 diabetic my entire life and the whole family ate in line with his diet. If I wanted a “treat” then it would be out somewhere or my mom would bake diabetic friendly alternatives. Just don’t bring the high carb food into the home is the easiest solution.

You need to weigh the pleasure of food against the suffering of poor wound healing and worsening cognitive decline with sugars in the 300s. My dad’s judgement is very off and he is “foggy” when his sugars are uncontrolled which makes life more difficult for everyone.

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I am doing that er diet but also need to moderate to some point so she doesn’t suffer more before death…im not trying to prevent death but prevent more suffering

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Hi, I agree with the pen suggestion, 600 is problematically high. I understand the needle fear. Maybe you could get the pen out and let her give you a couple pokes with it to show her it's painless? (don't dial up the insulin!) I let my daughter poke me and it felt like nothing.

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Thanks to our past president Obama who got my health insurance canceled I had sine 1982 my diabetes got out of control and I lost vision in one eye and damaged kidneys. But now years later it is back under control. it has been a long journey. I control it with diet. Following a “diet” will not work it needs to be a mental adjustment and lifestyle change. I am now mostly vegetarian. I do not eat sugar and minimize carbs. The trick for me was finding those types of foods l liked. Exercise is also very important and my biggest challenge. I control my sugar with just a couple of pills and my lifestyle changes. Unfortunately the damage is done. It can only be controlled by changing how you think about it.

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I will be 66 next month. Been an insulin dependent diabetic for years. I take 4 shots per day. I have been in the hospital with poor wound healing and other complications. I am not only on a diabetic diet but also on a dialysis/kidney diet, plus fluid restrictions. At some point if live to be elderly I'm going to throw the diet restrictions out the window and eat and drink what I want. And no well meaning child will stop me.

Your mom is 91 and is not going to live forever no matter how much you police her food. Let her have some freedom with her diet. I think at a certain age it's time to be free and throw caution to the wind.

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I am doing that er diet but also need to moderate to some point so she doesn’t suffer more before death…im not trying to prevent death but prevent more suffering

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I can totally relate! My mom has been a type 2 diabetic for many years and prior to her stroke when my brother and I took over the oversight of her medications it was for the most part very poorly managed. Now she suffers from stage 3-4 kidney disease, heart and vascular disease, eye disease…well you get the picture. Her problem has always been carbs and sweets and that hasn’t gotten much better even with better management. She has however been giving herself a daily shot of a long acting basal insulin for years along with oral meds so she doesn’t have that fear of shots but as she has aged her meds have had less affect as you have probably noticed too so her endocrinologist prescribed the Dexicom for continual blood sugar readings and the Omnipod 5 that works with it delivering insulin without having to give her shots. She isn’t able to manage these but we can and it’s been working really well. As long as someone is around to plug in the carbs she can eat much more of what she wants and that’s nice. It might be worth looking into.

I have also noticed that Mom seems to be able to tolerate higher BS than she used to be able too, a number that landed her in the hospital 10 years ago comes and drops without us panicking as much these days or did before the pod anyway. Still we know when she goes over that ledge somewhere around 200-225 because she becomes uncooperative, down right mean and can’t process why. With the Dexicon we have solidified what we always knew but she didn’t believe which is enough water and even a little bit of exercise, just moving around has a dramatic effect on lowering her blood sugar, we just need to get to it before she hits 200!

Mom is 81 with some dementia as well as aphasia so we want her to be able to eat what she wants just like you do with your mom but we also have to be able to live with and care for her so keeping her BS in line is important for our sanity not just her health and happiness. Happiness because she enjoys life more and health because she’s going to lose her eyesight if we can’t keep the swings at bay and I can’t imagine how we could manage dialysis should that come to pass.

Oh and the constipation, not sure what meds are causing that but Mom had that issue as well at one time and taking daily fiber as well as making sure she is getting the minimum amount of water she should, not an easy task, has made a huge difference in that department.

Hang in there your doing great!

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My mom tolerates sugars in the 300s and 400s….but I know that damage is being done to body anyway so I talk to drs and change meds etc change diet etc …I have palliative care …god only helps those who help themselves …I am doing that re looser diet but also need to moderate diet to some point so she doesn’t suffer more before death…im not trying to prevent death but prevent more suffering …

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Please discuss this with the doctor and inquire about Hospice and/or palliative care.

Let go and Let God...............mom is the captain of her own ship.

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I have palliative care …god only helps those who help themselves …I am doing that re looser diet but also need to moderate to some point so she doesn’t suffer more before death…im not trying to prevent death but prevent more suffering

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I see that you're trying to prevent further damage to her system and its very caring of you to have such concern over it. My father has alzheimer's and is also diabetic (he currently denies he is after 40 years of being diabetic). After discussing with my doctor the difficulties in micromanaging everything he eats, he suggested a glucophage prescription. He takes that now and I let him eat his favorite foods (within reasonable limits). I offer snacks, keto ice cream, keto lollipops, chips... but if we take restaurant trips to Sizzler (his fave) I never deny him his ice cream station treat. Its just not worth it for either of us to argue and sour our relationship. He is not at the point of non healing wounds, which I'm sure makes it even more difficult on you. Pills would be easier than a poke.

What many here are trying to get you to understand, I believe, is that you have your own life to live just as your mother did and rightfully deserves to continue to do so. You can only do so much after all.

Good luck finding your own personal balance! (absolute hardest part)

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HI. Ms Chung. What you said was nice but as a type 1 for 50 years, you are incorrect when you say a pill is better than a poke. Metformin is the most harmful drug in existence for diabetes. Gymena, cinnamon replace that. Also a product called Glucoburn lowered my dad's type 2 by 60 pts. Insulin, while not great, is the only treatment for 1's.. it doesn't cause your lungs to fill with fluids like Metformin.

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Mhillwt: I am glad to read your post further down this thread that your mother is on palliative care. I do hope that her blood sugar can be controlled by her eating right and not binging on carbs after big meals, which raises the question: how can her gastrointestinal tract process that much food?

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I am so sorry for the pain you are having. I am a type 1 diabetic for 50 years. I am currently in the ICU of my local hospital. Admitted with a blood sugar of 2200+. Small wounds on feet. Stress and depression caused this episode. Diabetes is a strange dis ease. Diabetics, on the whole, crave more sugar than the rest of the 7+billion people alive. Hiding it is most disconcerting and probably a fight.my Dr told me 40 years ago that diabetics usually die from terrible, horrible diseases. Maybe you'll be one of the lucky ones and have a heart attack instead. That was the best news I ever got. Sadly, the heart attack wasn't enuf. What I have found through all of this is that I have a loving God and that whatever I may do to myself over these 50 years, HE is always there to pick up the pieces. My trust in Him is unwavering. Let mom be mom. Happy. Trust God to be there when school is out. Just like you trusted her to pick you up after school. Not wringing your hands during kindergarten worrying she wouldn't come. That's the simple definition of faith. Enjoy your time with her. If you have her, she did something to earn it.

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I had a foster "friend" I called, "Mama" back in 1992 who was obese at 5'5" and had diabetes 2 who suffered a massive stroke and heart attack. After many hospital visits for 5 years, she died at age 77.

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Uncontrolled diabetes and diet in advanced elderly. Any advice?

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