More Tips for Caregivers of the Elder Generation

Do you have a parent that needs care, or older relatives needing to be cared for. This can mean many challenges for the “in-between” or sandwich generation. No, this is not a repeat of the last blog.

What are the problems that you will face if you take on the care of a parent or older relative? How will your children react? How will the parent(s) react? These are just two of a multitude of problems and hurdles you will face. Many problems may be financial and others will be dealing with human nature. When I speak about a parent I put the (s) after to indicate possibly both and I want you to understand this could also be an older relative like an aunt or uncle and even a distant relative that has been close to you or your family.

Decisions need to be made and sometimes there just does not seem to be enough hours in a day. Will the parent(s) be able to completely care for themselves, only care partially with some or many limits, or will they be totally unable to care for themselves.

Decisions need to be made about where the parent(s) is going to live. Will they be able to stay in the home, and will it be necessary to have round the clock supervision or just a daily visit or someone only during the day? If it is just one parent, do you have room for an additional person living in your house? Or will an assisted living facility or nursing home be necessary? How is the person going to be able to get to and from doctors and other appointments?

These are just a few of the decisions to be made concerning the parent(s). Will you be able to handle the finances for their care or does the parent have the money available? If you are a single parent, how will this affect you and your children? Even if you and your spouse have a stable marriage, looking after a parent can place a burden on the marriage.

This is the reason for the prior blog to provide sources of assistance. Always consider talking to a pastor or minister of your church as they also can often provide resources.

Finally, if the parent(s) will talk about this and make plans before something happens, then many steps can be saved and everyone will know what is expected.

Tips for Caregivers of the Elder Generation

Do you have a parent that needs care, or older relatives needing to be cared for. This can mean many challenges for the “in-between” or sandwich generation. This term, “sandwich generation”, was popularized in the early 1990's by Carol Abaya, an eldercare expert and columnist.

This is more a listing of organizations that may provide guidance or assistance for eldercare of your parent(s), or other close relative. Even though I will be listing several caregiver resources, do not forget that many eldercare religious organizations exist and may be good resources. Just because I use eldercare, many organizations have other names, “aging services”, and “elder homes” are just a few of the terms.

The following list of caregiver resources is not complete, but will give you ideas and may provide what you are looking for. Some people may not need this if their parents have planned properly.

The National Association of Social Workers (socialworkers.org) can assist you in locating social workers specializing in geriatric care.

The National association of Professional Geriatric Care Managers (caremanager.org) makes referrals to eldercare professionals, who (for a fee) will assess your parents' needs and help coordinate care.

Benefitscheckup.org lists federal, state, and local benefits (other than Medicare) for which you parents may qualify.

The American Health Care Association and National Center for Assisted Living (longtermcareliving.com) can walk you through long-term care and assisted living options.

The National Academy of Elder Law Attorneys (naela.com) is a source for legal information and eldercare attorney referrals.

You may not need many of these services, but you should have a list available. The next thing that is necessary, before your parents are not legally able to do this, is talk to your parent(s) about having a lawyer draft two documents of importance. The first is a durable power of attorney for finances and the second is a durable medical power of attorney for medical decisions.

Have the parents keep the documents up-to-date and in a secure place like a safety deposit box. Family members should know of their location. Have the parents check with the financial institution and notify the institution of any changes to prevent complications when they go into effect. Also check with the institution to find out if they have any additional requirements that need to be addressed.

If you are the trusted person for your parents, you may be present for all of this. If there are other family members, they need to be notified to avoid future conflicts and hurt feelings. Not all families members are accepting of this, but most will work with the family member chosen by the parents.

If you are a parent with children, consider doing this for your children to avoid future problems as well.

Tips for Family Members of A Diabetic

After laying out the problems many family members cause for other members of the family, it is time to offer some tips for family members that want to be supportive of a loved one with diabetes. Some refer to them as caregivers, but this is not always the case and many people with diabetes just need the positive support of other family members as they are very capable of caring for themselves, but would appreciate the support, especially if it is sincere and positive in nature.

Diabetes for many is a hard disease to manage alone, but is much more manageable with support of a loving family. When you are not the person with diabetes, it can be a herculean task to learn how to be supportive. So what can you do? As a person with Type 2 diabetes, I feel I can offer some valid suggestions.

If you are a spouse, you must have a talk with your husband or wife about what they would appreciate for support. When they say something, listen, listen, and do what they ask.  This may not be done in one session as there is a level of trust beyond marital trust that must be established and from my own experience, this does not happen overnight. It may take weeks, but as the person with diabetes sees that you are learning and sincere in your efforts, this will open up other areas for discussion.

Do not push, let things happen, but be there. Let your partner know this verbally and with feelings, and this is probably the best tip. Together, you can learn about diabetes. If the one with diabetes suggests reading something, do it. This will create common ground for discussion. More areas for discussion can be enhanced by going to the doctors appointments with your partner. If the partner with diabetes does not wish this, be careful, but continue the discussion. If they relent, make sure that you discuss the questions you may have.

This is a tip and a warning. Do not try to manage the others person's diabetes. This can cause more problems than solve problems. It is better to just be there for them. Let them know about your feelings and how their diabetes may affect you.

Some very good ideas include exercising together, choosing healthy foods, offer encouragement, and be supportive and considerate. Exercising together can often give you some time to just be together and have discussions or as some term it “your time”. Being supportive means helping with lifestyle changes and encouraging them at the pace that works for the person with diabetes. Just knowing that you are there and supportive will help make changes easier.

Some people suggest being in a support group together, but I have some reservations about this. This may be the separate time for each of you that allows for them to be themselves. This will depend on how you function as partners and how comfortable it is to be together in every situation. I just advise using caution. It may also depend on the people in the support group.

If there are children, their ages may determine some of the activities and affect the support that is needed. Do not allow children to pull away and not be supportive. For teenagers, this can be very difficult. Adult children will normally go along with whatever is reasonable.

I have kept this for the partners in a marriage or relationship and intend to talk about the older generations in another blog.

Who Prevents Good Diabetes Management? - P3

Is it family members? How I dislike saying yes, but family members can be the worst in preventing good diabetes management. Why would I say this about loving family members. Well, loving family members can be the least understanding and the most unwilling to learn about diabetes. They just want you to take a pill and return to the life you filled with them before diabetes.

Many family members could care less about diabetes because you do not look sick and are doing the same things for them that you were doing before diabetes. Even your loving spouse can totally ignore diabetes and not want to learn about it. Why would I say these things? Because I read about this on many diabetes forums. Husbands or wives not supporting the spouse with diabetes.

Then the family members can be very irritating when they become the diabetes police. Asking you why you can still eat that piece of candy or cake when it is loaded with sugar. Even though you have allowed for this treat and compensated for it with what you have eaten, they will still not leave the subject alone. They don't understand that sugar is not the only thing you need to be careful of.

They do not understand why you will not eat many foods and have very small servings of others. They start hearing horror from well meaning friends and translate this to fear about you developing the same problems. They become your worst nightmare as the diabetes police and some can become very belligerent in their actions.

Then there are those family members that will just not cooperate. You have gotten rid of the junk food and are working to convert everyone to more healthy foods and doing more cooking and serving more fresh foods. They insist on eating no differently than the past and won't accept the change like they won't accept that you have diabetes.

There are families that do support each other and do whatever they can do to make things easier. They know and accept the change in foods and understand that things are now different and they are benefiting as well by the changes being made. This makes for a much more loving family and home. If you are so blessed, do everything to keep this blessing and make it grow.

Back to you! Now to complete the thoughts from the first part of this blog series. Yes, I am back to talking about the person with diabetes. No, I'm not going to give you a pass. We have all been through the stages of grief many people experience after receiving the diagnosis of diabetes. So get over the anger, put the denial behind you and make up your mind that you want to live and manage diabetes.

Learn that diabetes is not your fault. Could you have prevented it? Not likely. If doctors would have done screening on a regular basis, maybe, if they had paid attention to the results. The one chance you had may have passed. But if you are strong willed and decide, if you are medically able, to do the exercise and nutrition with enthusiasm, you may be capable to getting off medications for a period of time. This will depend on the damage already done to your pancreas. Some are able to stay off medications for decades while others only for a few years.

Most people do not comprehend that because diabetes is often different for each person, that they have now become their own science experiment. Testing can be very difficult as Medicare and most medical insurance companies are strictly limiting test strips that they will reimburse. Testing is a must to determine how your body reacts to different foods. Testing is also necessary to give you a report on how you are managing diabetes. Numbers are just numbers if you don't make use of them.

Good luck and learn to manage your diabetes, deal with those around you, learn to make the best use of your doctor(s), and other resources.

This is the end of this series. (3 of 3)

Who Prevents Good Diabetes Management? - P2

Is it the diabetes educator? Yes once more, for many and varied reasons. If you have received a referral, this person can get in the way. Sometimes it is not intentional, but they sometimes lack the ability to think for themselves and settle into poor habits of thinking they and only they are right and forgetting about the needs and maybe the goals of the patient. They should not openly disagree with the doctor, but many do.

If done properly, they can be of great help to the patient. The largest problem is the lack of diabetes educators so many areas of the country just do not have them available. Many others have not left the profession, but are not working with patients because they have related jobs and some are authors and will never be available to advise patients. Some have good books and some have books.

So if you get one that understands diabetes, personal goals, what the patient desires, and what the patient is capable of, treasure this person. Make use of what they have to offer and get questions answered. They will communicate with your doctor and see that you receive the best outcome. In some states, these educators are not licensed, but still have much knowledge and are able to communicate at all levels.

It is the dietitian? I must continue to answer yes. These people sometimes are so wrapped up in following the guidelines of their national association and other medical groups that they forget about the help patients need to battle diabetes. They are locked into dogma and mantra's that are losing favor among the rest of the population.

It is unfortunate that they are so locked to low fat and whole grains that they push these ideas to the exclusion of patients needs. One person who will never talk to a dietitian has celiac disease and cannot tolerate any wheat products. She was still advised to eat whole grains even after explaining that she could not eat whole grains and that she had celiac disease.

There are many good dietitians that are not fearful of their job and work for and with patients, doing what ever is necessary to serve the nutritional needs of people with diabetes. They work with people to make nutrition first and at the level that the patient desires to be able to achieve their goals.

The problem many people have is locating a good dietitian that knows diabetes and can work with you. People living in rural areas may not be able to locate a dietitian or have to travel hundreds of miles to see one.

Both the educators and dietitians can be assets to doctors and they can help patients when they can put their own importance and titles behind them on a shelf or wall and don't wear them on their lapels constantly remind people of their importance. These are the ones that are also assets to patients.

I will be covering more in part 3. (2 of 3)

Who Prevents Good Diabetes Management? - P1

Not an easy question to answer. Many think they have an answer. Bear with me for some questions and potential answers.

Is it you? Yes, and this is often the answer. We are often our own worst enemy. For what ever the reason, we can many times find ourselves to blame for non-management of diabetes. We should not blame ourselves for developing diabetes, but many cannot get past this and become the person at fault for not managing their diabetes. I will return to this at the end.

Is it the doctor? Yes again and for many reasons. First, lets define the potential range of doctors that may be potentially involved. Many people can have a general practitioner. Others will use a doctor of internal medicine. Some will have a doctor known only as a family practitioner. Still others will have a primary care physician. Very few of these will specialize in diabetes, but some will be very knowledgeable about diabetes because they have spent the time to stay current with the developments. Others will have little or limited knowledge and if they are good, they will adapt and learn. Some of the better doctors will refer patients to doctors that know about diabetes.

Then there are doctors that specialize in the endocrine system, but still may not be knowledgeable in diabetes. Then we have those that specialize in diabetes. And even then there are quality endocrinologists and those that are not. As with any doctor, it will take a good fit between patient and doctor to have great success. Others can have good success with a less that perfect partnership.

What needs to be recognized is many doctors just don't pass on information to assist you is managing diabetes. Or they refuse to get you to classes that would instill the reasons for management and how to manage diabetes effectively. Some will not work with you to battle the medical insurance monopoly to get you the testing supplies to help you get started. Many just don't want you testing your blood glucose as they want to be in charge and do not want you to become discouraged when the results are not good.

If you have one of these doctors, you should seriously consider finding another doctor if it is possible. I realize that many people live in rural areas where doctors are few and far between. In these situations, it may be necessary to stay with a doctor and attempt to get education if possible from the internet, but that can sometimes be difficult in some rural communities.

In these extreme situations, you may need to work more intelligently with your doctor and even beg for testing supplies and encourage the doctor to become more knowledgeable. An acquaintance of mine needs to drive 90 miles one way to the nearest doctor. He is very fortunate that the doctor is knowledgeable about diabetes and encourages use of the internet and also works with him to answer questions via emails. This is the exception, but it works for both of them. His appointments are also a rare thing as he is often there for a full half an hour, when needed.

So if you have a doctor that you can work with, consider it a blessing and cultivate the good relations and ask questions.

I will be covering more in part 2.  (1 of 3)

Cook to Resolve Your Food Issues

I guess that I was very lucky when my first wife died of cancer. The last several months of her life, she worked on getting me to cook, yes, simple dishes and when I complained about them being tasteless, she told me to get a certain cookbook and do some reading that she selected. I used a post-it to mark the section on using herb and spices and still refer to it.

No, I don't do as much cooking as I am remarried and my wife loves to cook. But I still love being in the kitchen. I am learning other things now, like doing the dishes without a dishwasher. No this I learned on my own after I sold the house. I do help with chores and some food prep, like chopping vegetables in various sizes.

This article in WebMd is very good and should be read by anyone that does need to cook and has not learned to cook. If you have started, this is still good. It has a list of kitchen tools. I have that and a few more, but the best tools are an excellent set of knives for the many uses. I seldom use the food processor and it sits. I do have a very small processor for onions and a few other foods. Yes, I will not do more than cut the onions to fit in the processor and then let it do its magic – mostly on the pulse mode.

Doing your own cooking is very important as it allows you control over the foods and lets you do what is necessary to limit sodium (salt) and the amount of cholesterol that you eat, to say nothing of sugars, especially high fructose corn syrup (now renamed corn sugar) that you can keep out of your foods.

While many people detest cooking from scratch, it is the most healthy and rewarding. I have not made bread for several years, but I am rereading about this and may do this again. I will not be using wheat, rye, or oat flours. This is why I need to do more reading.

Another good source of information is a blog by Amy Campbell.   Select the year to read many excellent blogs on cooking. They may not be specific enough for those of us with diabetes, but there is much information that can be adapted quite easily. She runs many series for four to six or more blogs about the same topic and then starts another topic with a sprinkling of other excellent ideas mixed in for good measure.

Lessons Diabetes Teaches Us – Part 2

Hopefully you have read David Spero's blog from my last blog. If not, go back and read the previous blog here. Now for some more lessons from the college of hard knocks about diabetes.

These are some of the problems associated with diabetes and some are considered short-term complications. A brief list includes hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic coma (HHNKC). The last two need immediate medical intervention. Hypoglycemia may require immediate medical intervention of the blood glucose levels gets too low.  Read about the short-term complications here.

Certain oral medications can cause hypoglycemia and is is very common for those on insulin. People that become hypoglycemically unaware need to be especially cautious about letting their blood glucose levels get low. DKA is normally associated with Type 1 diabetes, but a few Type 2's can have this problem. HHNKC is generally for those with Type 2 diabetes who let their blood glucose levels get above 600 mg/dl for extended periods.

A word of caution to all people with diabetes, if you live alone, make sure that you have family or friends available for assistance if needed. If you live in an area and know other people that have diabetes, get to know each other for support and to check on each other.

Other effects that are associated with diabetes are loss of sexual drive – erectile dysfunction in men, urinary track infections (UTIs) in women. Also relevant are heart disease and diabetes, stroke and diabetes, and high blood pressure and diabetes. Most doctors will automatically screen for these and prescribe medications to alleviate the problems, but a few do not. So be prepared to ask for these screenings.

If you are able to manage your blood glucose levels, then there are some sneaky problems that still can make themselves present. Depression can assert itself. Most people with diabetes, about 67 percent, are likely to develop mild depression and then there is about 19 percent that may develop severe depression. Mild depression can be helped with antidepressants and the more severe should be treated under the care of a doctor. Read my blog on depression here. Even excellent management of diabetes is not a guarantee that you will not have depression.

Over 50 percent of people with diabetes, are likely to develop sleep apnea. Most because they are overweight and have apneas up to several hundred times a night which interrupts your sleep and you feel over tired during the day. There are several treatments available depending the the severity of the sleep apnea and the type. See my blogs here for further details: blog 1, blog 2, blog 3, blog 4, and blog 5. There are other blogs, but I have provided those relevant for this discussion.

Another link to diabetes is dementia, in particular, Alzheimer's disease. There is a proven link between the two now so that it cannot be ignored. So for those of us in our golden years, you do need to be concerned.  Read David Mendosa's blog here and my blog here.

There are other problems such as skin problems caused by diabetes. Some skin problems need immediate attention, but others can be treated with various medications and skin conditioners. There are other other minor complications that few people have problems with. The big four were covered by name in the first part.

Some will say I did not cover amputations, but I am. They can result from two of the big four. Neuropathy and atherosclerosis are the cause of poor healing and lead to amputations when not properly and immediately cared for. So make sure that you take excellent care of your feet and legs, inspect them daily and see a doctor if a problem develops.

Many people insist that every little health problem is caused by their diabetes and this is just not so. There are other diseases that people with diabetes can get, but as of yet, there is no firm or related link to diabetes resulting in posing a risk to have the disease.

Most people that manage diabetes and are able to maintain blood glucose levels near normal very seldom develop complications. It is when people do not manage their blood glucose levels that they will develop the complications. Retinopathy seems to happen first, but they may all develop to some level at the same time.

I have had three friends or acquaintances that had diabetes that they did not manage their diabetes and they went on dialysis. All three have passed in the last 18 months because they could not or would not continue the dialysis. Another friend had both her legs amputated above the knees because she did not manage her diabetes. She is now approaching the end of her sight because she has continued to not manage her diabetes.

So life's lessons can be hard for some and others do very well. How are you managing diabetes. Has the college of hard knocks helped? Or have you ignored the lessons of life handed to you?