How to Be a Caregiver for Someone With Diabetes

Learn your loved one’s diabetes management plan

Not everyone with diabetes gets the same management plan, so caregivers should make sure they understand the details, says Neil Skolnik, a family physician who cohosts the diabetes association’s podcast Diabetes Day by Day.

“It’s important as a caregiver to understand the right questions to ask,” he says. To start with, he suggests: “What’s our plan with regard to diet? What is our plan with regard to physical activity? And what are the right medicines that we're going to use?”

He says it’s important to realize that “the medicines aren't like they were in the old days … when the only goal was to get that sugar down. We live in a different world now.” Now medicines are individualized based not only on blood sugar levels but also a person’s other health risks and conditions, such as heart disease and obesity, he says.

Another area of variation: blood glucose testing. Caregivers need to know whether and how often their loved one should check levels at home and how often they need to go to a lab for a test of their A1C — a measure of blood glucose levels over the previous three months. A doctor might not recommend routine self-testing in someone managing diabetes with minimal medication or diet and exercise alone, according to the diabetes association.

Blood glucose goals also vary, Skolnik says. The low target that’s right for a fairly healthy 65-year-old may be too risky for a frail 95-year-old, he says. The risks of pushing blood glucose too low include mental confusion, seizures and falls.  

Getting a plan in action can require a lot of a caregiver, says Angelica Herrera-Venson, a gerontologist who runs a caregiving site called Kapok and is associate director of data management and evaluation at the National Council on Aging. Caregivers often become “master planners,” tracking appointments, medications and supplies, she says. They also become “super detectives,” she says, figuring out what works.

Diane Burk can attest to that. She says she’s learned, for example, that “four grapes” will spike her husband’s blood glucose, but that a couple of pancakes will not. Half a big potato is OK, she says; a whole potato is asking for trouble.

Be a supporter, not a police officer

When it comes to making diet and activity changes and sticking to medications and testing routines, caregivers and their loved ones may not always be on the same page.

So, what do you do when your husband insists on the bowl of ice cream that will spike his blood sugar or your mother keeps skipping her daily walk?

“The key is to be respectful,” Eichorst says. “People change in their own ways. It’s not easy to make a lot of lifestyle changes.”

She suggests urging your loved one to focus on one habit at a time — like having a healthier breakfast this week and walking a few more steps next week. Then celebrate those accomplishments.

Herrera-Venson says it can help to show them how to keep their favorite foods in the mix. There are diabetes-friendly cookbooks for everything from Mexican to soul food, she says. The ice cream lover might be OK with a smaller serving, a low-carb version or another dessert, and there are more healthy options than people might think, she says.

“In the old days, they talked about a diabetic diet. There is no such thing now,” Skolnik says. “There’s a healthy diet.” Such a diet is low in added sugar and processed foods and includes plenty of non-starchy vegetables, like broccoli and carrots, along with fruits, healthy fats, and protein from lean meats or plant sources, according to the diabetes association. It does not eliminate carbohydrates, which everyone needs to live, Eichorst notes.

If you live with someone with diabetes, you can help by eating the same healthy foods, Skolnik says: “We do our best when we’re all in it together.”

Diane Burk says she eats what her husband eats —  “I don’t make two meals” — but treats herself to spaghetti or macaroni and cheese when she’s eating alone or out with friends.

Try to prevent complications and adjust as needed

To lower the heart risks associated with diabetes, you may hear that your loved one should follow the ABCs. According to the CDC, that means:

A: Getting regular A1C testing

B: Keeping blood pressure below the target set by their doctor

C: Managing cholesterol 

S: Not smoking

Diabetes also can damage the eyes, so expect your loved one to need regular eye exams. And it can damage nerves, which can lead to problems such as unnoticed sores on the feet that get dangerously infected. If your loved one can’t check their own feet, you may need to do that every day, Herrera-Venson says.

Eichorst says one important way to prevent complications is to avoid “therapeutic inertia,” which means not changing treatment when it isn’t working. “Too many with diabetes have an A1C that’s higher than the desirable range, but they’re still on the same medication,” she says. Talk to your loved one’s doctor if that’s the case, she urges.

Complications are not inevitable, Skolnik says. Newly diagnosed people and their families often “are very worried” about all the things that can go wrong, he says.  But, he says, “most people do well.” 

Think mental wellness — for them and for you

Having diabetes doubles a person’s risk of depression, Eichorst says. When people are depressed, they are less likely to take care of themselves, Herrera-Venson notes. So, someone not taking their medications or otherwise neglecting their health may be showing signs of depression, she says. Talk to their doctor about it, she urges.

Support groups and mental health professionals can help both the person with diabetes and caregivers to cope, Eichorst and Herrera-Venson say.