Diabetes in an older parent: what changes with age, and the help at home

An older parent with diabetes is far more likely to have type 2. Somebody with type 1 has usually been taught by their diabetes team how to adjust insulin around food and activity, and may have done it for most of their life. What changes is less the condition than the person's ability to keep up with it: eyesight, memory, appetite and steady hands all play a part. The basics of what diabetes is, and its symptoms, are on what is diabetes?.

If you do not know which type your parent has, which medicines they take for it, or whether they have a written plan from their diabetes team, those are the first three things to find out. Your parent can tell you, the repeat prescription lists the medicines, and the GP surgery can share more with your parent's agreement.

None of this happens to everybody, and many older people manage their diabetes well. What changes is the questions worth asking. A useful one for a family is whether the treatment still suits the person your parent is now, not the person they were when it was first prescribed. Low blood sugar in later life has its own guide: hypos in older people sets out how one can look, the NHS steps for treating it, and when to ring 999.

The reasoning behind this is simple to follow. Keeping blood sugar low over many years protects the eyes, kidneys and feet, but that benefit builds slowly. For someone who is frail, at risk of falling, or living with several other serious illnesses, the danger of a hypo today can outweigh a benefit that would arrive a long way in the future. NICE says to consider relaxing the target in exactly those circumstances, and to agree it with the person case by case. It also says the effort of reaching a target should not be allowed to spoil the person's quality of life.

We have deliberately not printed target numbers here. They are agreed with your parent's own GP or diabetes team, and a number taken from a website, or from somebody else's plan, can be the wrong one for them. What a family can do is ask the question. At the next review, ask what your parent's target is, whether it has been looked at since their health changed, and whether any of their medicines carry a risk of hypos. NICE publishes a patient decision aid on agreeing an HbA1c target that the GP can use for exactly that conversation.

Diabetes UK says the GP surgery should get in touch to arrange the annual review, and that if you do not hear from them you should ring for an appointment. It also says the review should include a look at your parent's medicines. If a hospital diabetes clinic does some of the checks, ask them to send the results to the GP so nothing is done twice and nothing is missed.

The foot care and eye screening guide covers the daily look at your parent's feet between checks and what each result means. The NHS page on diabetic eye screening explains what happens at the clinic, and Diabetes UK lists the full set of checks on its page on diabetes health checks.

Who gives these medicines is the question families ask most. Tablets are straightforward. A carer can remind your parent that a dose is due, read the label, open the pack, and write down what was taken. That is prompting and assisting, and our guide to whether a private carer can give medication explains where that ends and administering begins.

Insulin is different. Many older people inject their own insulin for years, and a carer reminding them that it is due is still prompting. Giving the injection is a clinical task. A carer does it only where a healthcare professional, usually the district nurse, has trained that named carer on your parent and their equipment and has handed the task over in writing. Otherwise the injection stays with your parent, a trained family member or the district nurse. The same applies to blood sugar testing done as a clinical task, and nobody but the prescriber changes a dose. Insulin at home explains how that handover works and what to ask the district nurse.

The guidance also points out that a hypo can look like the dementia getting worse, and that repeated hypos in an older person can be mistaken for cognitive decline. So if your parent seems suddenly more confused, ask whether their diabetes medicines could be part of it. The GP or diabetes nurse may agree a higher blood sugar level at which a hypo is treated, and may stop a medicine that carries the risk.

A lasting power of attorney for health and welfare lets a family speak for a parent when they can no longer take part in these decisions themselves. It can only be made while your parent still has the mental capacity to make it.

The family's part can be the organising: keeping a list of medicines, going to the review, chasing the eye screening letter, and making sure the people who help know the plan. A diabetes care plan for home shows how to put that on a single page. The eating well guide covers meals when appetite is poor.

If you would like somebody to take on the meals, the tablet prompts and the appointments, you can search for carers near you and compare their rates. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 at an agency. You choose the carer, meet them first and agree the visits and routine directly with them, and you can keep the same person. Every carer has had an identity check, a right to work check and an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 2 years, and has been interviewed online. Carers are insured while they work. There is no way to search for carers by diabetes experience, and we do not check training or qualifications, so what a carer says about diabetes on their profile is their own account to ask them about at interview.

Other conditions that can come with diabetes have their own guides on the pillar, including kidney disease and dialysis days and high blood pressure in later life.