Eating well with diabetes in later life

An older person who is still a healthy weight and eating well may be given much the same advice as anyone else. One who is frail, losing weight or eating very little needs a different emphasis, and Diabetes UK says that person should have a nutritional assessment and advice from a dietitian.

Diabetes UK also notes that eating can be harder in later life for reasons that have nothing to do with diabetes: sore teeth or loose dentures, medicines that upset digestion, poor eyesight, stiff hands, swallowing problems and low mood. TREND Diabetes adds that a dentist should see anyone whose teeth stop them eating properly, and that a doctor should hear about swallowing difficulties or medicines that take the appetite away. Each of these is worth sorting before anybody talks about a diet.

Three meals and two or three snacks at roughly the same times each day keep food arriving steadily, which protects someone on hypo-causing medicines. Diabetes UK says regular mealtimes and snacks help prevent hypos, and that lower appetite or irregular eating is a common cause of them. It also notes that many older people find their warning signs of a hypo become less obvious, and some have none at all, so a missed lunch can lead to a hypo without the usual shaking or sweating.

If your relative takes metformin on its own, or manages their diabetes by diet alone, a late meal is unlikely to cause a hypo. Regular meals still help them eat enough across the day. If you are not sure whether their tablets can cause a hypo, TREND Diabetes suggests asking the pharmacist. Our guide to hypos in older people sets out the signs and what the NHS says to do.

There is no need to buy special products. Diabetes UK says there is no such thing as a diabetic diet, and the British Dietetic Association says foods labelled as suitable for people with diabetes have no special benefit. Nobody should start cutting carbohydrates hard without talking to the team. Diabetes UK says not everyone with diabetes needs to restrict carbohydrate, and that anyone on medication that can cause a hypo should check with their healthcare team before cutting down.

Diabetes UK warns that the signs of a hypo are sometimes mistaken for being drunk, so somebody who has had a glass of wine and becomes muddled may need sugar rather than a lie-down. If drinking enough water is the bigger worry, our guide to elderly hydration covers why older people drink less and what helps.

1. 1

   Notice the change and write it down

   Now

   Weigh them once a week on the same scales if they will agree, or note how their clothes fit. A date and a weight, or a note that a belt has moved a notch, gives the GP something to work with.
2. 2

   Offer little and often

   Every day

   The British Dietetic Association suggests eating little and often rather than large meals, with two nourishing snacks a day.
3. 3

   Make each mouthful count

   Every day

   The NHS suggests fortified foods that are high in calories and protein, and drinks that contain calories. The British Dietetic Association names milky drinks, malted drinks and hot chocolate, and stirring dried milk powder or grated cheese into food.
4. 4

   Tell the GP and ask about a dietitian

   This week

   The NHS says to see a GP after unintended weight loss over 3 to 6 months. Diabetes UK says an older person at risk of undernutrition should be assessed and see a dietitian. Ask too whether the diabetes medicines still suit how much they eat.

The last step matters for diabetes in particular. Diabetes UK says a lower appetite can cause hypos, so medicines set when your relative ate full meals may need a review once they eat less. TREND Diabetes says the doctor may be able to change tablets that cause hypos to ones with a lower chance of doing so. That decision belongs to the GP or the diabetes team, and the family's part is to tell them that eating has changed. Never stop, start or change a diabetes medicine yourselves.

Illness is the other time appetite disappears. A cold, an infection or a stomach upset can push blood sugar up even when the person is hardly eating, so ask the GP or pharmacist for written sick day rules before you need them. Our guide to when someone with diabetes is unwell goes through those days, and what happens when the elderly do not eat enough explains why weight loss in later life is taken seriously.

Keep the cupboard and freezer topped up so there is always a fallback. Ring-pull tins and small packs are easier for stiff hands. If your relative takes insulin or a tablet that can cause hypos, the hypo treatments are the most important shelf: everyone in the house, and any carer, should know where they are kept.

A regular online order with delivery means the basics turn up without anyone having to remember them. Going to the shop together once a week lets the person choose what they like to eat. Shopping, cooking and laying the table count as care, and our guide to shopping, cooking and cleaning as care explains what that help includes.

TREND Diabetes also says a person with dementia may not recognise the signs of a hypo or be able to treat it themselves, so whoever is with them needs to know what a hypo looks like for this person and where the treatments are kept. If chewing or swallowing has become difficult, or they are losing weight, ask the GP to refer them to a dietitian. Our dementia care pages cover the wider picture.

How a carer helpsSection titled How%20a%20carer%20helps

A carer cannot treat diabetes, and what they do is make the meals happen. That can mean doing the shopping, cooking a hot meal, sitting down to eat with your relative, prompting the snacks between visits, writing down what was eaten, and noticing that clothes are getting loose or the fridge is full of untouched food. If that is the help your relative needs, you can search for carers near you who can help with shopping and meals, and compare their rates. Carers on PrimeCarers charge £18 to £25 an hour, with our fee included.

A carer can prompt prescribed tablets and record what was taken. Insulin injections and blood glucose testing are different: they happen only where a healthcare professional, usually the district nurse, has trained the named carer and delegated the task in writing, and otherwise they stay with your relative, the family or the nurse. Our guide to insulin at home explains how that works.

Every carer on PrimeCarers has had their identity and right to work checked 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. What a carer says about it is their own account on their profile, so ask them about it when you meet, and check what matters to you. You choose the carer, meet them first and agree the visits and the routine with them directly.