Diabetes is one of the most common chronic conditions among elderly people, affecting approximately 20% of those over 75 years old. Its daily management requires constant vigilance and close coordination between healthcare professionals, home care assistants, and the person themselves. For home care workers, understanding the basics of diabetes, knowing how to recognize warning signs, and knowing the limits of their role is essential to effectively contribute to the safety and well-being of the diabetic individuals they support.
This comprehensive guide presents the fundamentals of diabetes, blood glucose monitoring, prevention of complications (especially podiatric), recognition and management of hypo and hyperglycemia, and the role of each actor in this shared care approach.
Understanding Diabetes
What is Diabetes?
Diabetes is a chronic disease characterized by excess sugar (glucose) in the blood. This hyperglycemia results from a defect in the production or action of insulin, the hormone that allows glucose to enter cells.
Type 2 diabetes is by far the most common in elderly people (90% of cases). It involves:- Resistance of cells to the action of insulin
- Progressive decrease in insulin production
It develops gradually, often associated with overweight and sedentary lifestyle.
Type 1 diabetes is rarer and usually occurs in young people. The pancreas no longer produces insulin and insulin treatment is essential.The Risks of Uncontrolled Diabetes
Poorly controlled diabetes, over the long term, leads to serious complications:
Cardiovascular complications: heart attack, stroke, peripheral arterial disease.Kidney complications: kidney failure that may require dialysis.
Eye complications: diabetic retinopathy that can lead to blindness.
Neurological complications: neuropathy (nerve damage, especially in the feet).
Infectious complications: increased vulnerability to infections.
Podiatric complications: foot wounds that can progress to gangrene and amputation.
Treatment Objectives
The goal is to maintain blood glucose within an acceptable range to prevent complications, while avoiding dangerous hypoglycemia.
In elderly people, targets are often less strict than in younger patients, because the risk of hypoglycemia is more dangerous in the short term than that of moderate hyperglycemia.
Blood Glucose Monitoring
Monitoring Tools
Self-monitoring of blood glucose:- Measurement of capillary blood glucose (at the fingertip)
- With a glucose meter and test strips
- Variable frequency depending on type of treatment and medical instructions
- Laboratory measurement
- Reflects blood glucose balance over the past 3 months
- Performed every 3 to 4 months
- Small sensors placed under the skin
- Continuously measure interstitial glucose
- Increasingly used, even in elderly people
The Role of Home Care Assistants in Monitoring
What home care assistants can do:- Remind the person to check their blood glucose
- Observe that monitoring is performed
- Record results if the person requests it
- Report abnormal values to the nurse or doctor
- Perform capillary blood glucose testing (except with specific authorization)
- Interpret results
- Modify treatment
Diabetic Diet
Basic Principles
The modern diabetic diet is no longer a severely restrictive diet but a balanced diet:
Meal regularity: three meals a day at regular times, possibly with snacks.Carbohydrate balance: carbohydrates (starches, fruits, sweet products) are allowed but in controlled amounts and distributed throughout the day.
Limit fast sugars: sodas, candies, pastries... especially between meals.
Favor fiber: vegetables, whole fruits, whole grains, which slow glucose absorption.
Monitor fats: limit saturated fats (butter, deli meats, cheese) to prevent cardiovascular complications.
The Role of Home Care Assistants
During shopping:- Help choose appropriate products
- Be vigilant about "traps" (products "reduced" in sugars but high in fats, etc.)
- Apply the dietitian's advice
- Balance meals
- Vary the diet to maintain pleasure
- Ensure the person eats enough (risk of malnutrition + hypoglycemia)
- Respect meal times, especially if the person is on insulin
Diabetic Feet: Critical Vigilance
Why Are Feet at Risk?
Diabetes weakens the feet in two ways:
Neuropathy: the nerves in the feet are affected, resulting in:- Loss of sensation (the person no longer feels injuries)
- Foot deformities (favoring abnormal pressure points)
- Dry and fragile skin
- Poor blood circulation
- Difficult healing
- Risk of gangrene
Daily Prevention
Daily foot inspection is fundamental:- Look at each foot, top, bottom, between toes
- Use a mirror if the person cannot see
- Look for: redness, wounds, cracks, corns, calluses, fungal infections, ingrown toenails
- Daily washing with lukewarm water (not hot, risk of unfelt burn)
- Careful drying, especially between toes
- Moisturizing with cream (not between toes)
- Cut nails straight, without cutting corners (or entrust to chiropodist)
- Comfortable, well-fitting shoes without injurious inner seams
- Cotton socks, without thick seams, changed daily
- Never walk barefoot
- Prolonged foot baths (maceration)
- Hot water bottle or radiator against feet (burn)
- Self-treating corns or calluses
- Using corrosive products
The Role of Home Care Assistants
Inspect feet during bathing: immediately report any abnormality.Apply hygiene care according to recommendations.
Alert in case of:
- Wound, even small
- Redness that does not disappear
- Swelling, warmth
- Discharge, bad odor
- Pain (if felt)
A foot wound in a diabetic person is an EMERGENCY requiring prompt medical consultation.
Recognizing and Responding to Glycemic Emergencies
Hypoglycemia
What is it?Blood glucose that is too low (generally < 0.70 g/L). This is the most immediate emergency in a treated diabetic person.
Causes:- Missed or insufficient meal
- Unusual physical activity
- Medication overdose (insulin, sulfonylureas)
- Error in timing of medication
- Alcohol
- Sweating, pallor
- Trembling
- Intense hunger
- Sudden fatigue
- Concentration problems, confusion
- Visual disturbances
- Unusual behavior (irritability, aggression)
- Dizziness, feeling faint
1. Don't panic
2. If the person is conscious and can swallow:
- Immediately give fast sugar: 3 sugar cubes, a glass of fruit juice, a spoonful of honey
- Wait 15 minutes
- Repeat if signs persist
- Then give a snack (bread, biscuit) to stabilize
3. If the person is unconscious or cannot swallow:
- Do not give anything by mouth (risk of choking)
- Call emergency services (15) immediately
- Place in recovery position if necessary
Hyperglycemia
What is it?Blood glucose that is too high. It is less urgent in the short term than hypoglycemia but must be reported.
Causes:- Diet too rich in sugars
- Forgotten medication
- Infection, intercurrent illness
- Stress
- Corticosteroids
- Intense thirst
- Abundant urination
- Fatigue
- Blurred vision
- Nausea
- Encourage drinking water
- Check that treatment was taken
- Report to nurse or doctor
- Close monitoring
Shared Roles in Diabetes Management
The Doctor
- Makes the diagnosis
- Prescribes treatment
- Sets blood glucose targets
- Adjusts treatment
- Monitors complications
The Nurse
- Performs capillary blood glucose testing if necessary
- Administers insulin if prescribed
- Educates patient on self-monitoring
- Monitors feet
- Coordinates care
The Dietitian
- Establishes an adapted meal plan
- Educates on carbohydrate equivalents
- Adapts to tastes and habits
The Podiatrist
- Specialized foot care
- Prevention of lesions
- Regular consultations (reimbursed for at-risk diabetics)
Home Care Assistants
- Observe and report abnormalities
- Help with balanced diet
- Remind about medication intake
- Inspect feet during bathing
- Recognize signs of hypo/hyperglycemia
- Apply first response measures in case of hypoglycemia
- Transmit information
The Diabetic Person and Their Family
- Actively participate in their care
- Follow recommendations
- Report difficulties
- Know warning signs
Cognitive Stimulation and Diabetes
The Link Between Diabetes and Cognition
Diabetes increases the risk of cognitive decline and dementia. Repeated hypoglycemia can also impair cognitive functions.
The SCARLETT program from DYNSEO allows stimulation of cognitive functions in elderly diabetic people. Maintaining regular cognitive activity contributes to overall well-being and can help preserve the abilities necessary for daily diabetes management (treatment adherence, recognition of warning signs...).
Training and Resources
Training for Better Support
The "Stimulate and Create Connection with DYNSEO Games" training develops essential relational skills for supporting people with chronic diseases like diabetes.
Practical Resources
The Home Care Assistant's Toolbox from DYNSEO offers concrete resources for supporting people with chronic conditions.
Conclusion: Daily Balance
Diabetes management is a constant balance between diet, treatment, and monitoring. This balance is everyone's responsibility: doctor, nurse, dietitian, podiatrist, home care assistant, and of course the person themselves.
Home care assistants, through their daily presence, play a key role:
- In observing and reporting abnormalities
- In helping with balanced diet
- In foot inspection
- In recognizing glycemic emergencies
- In transmitting information to the care team
Knowing your responsibilities and limits, observing carefully, transmitting faithfully: these are the pillars of safe support for diabetic persons.
DYNSEO supports professionals with cognitive stimulation tools, training, and practical resources. Because supporting a chronic disease means supporting a life, day after day.
Additional DYNSEO Resources: Article written by DYNSEO, specialist in digital solutions for healthy aging and support for cognitive disorders.