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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"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 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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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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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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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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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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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.

Uncontrolled diabetes and diet in advanced elderly. Any advice?

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