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How to Be a Caregiver for Someone With Diabetes

There’s plenty you can do to help them live their best life

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When Diane Burk married her husband, Jack, at age 57, one of the first things she did was take a cooking class — but not because she never learned how to cook.

She wanted to learn to cook for Jack, who was struggling to control his type 2 diabetes. “Not only was I a newlywed, but I suddenly had to figure out how to feed a diabetic,” says Burk, now 69, of Hammond, Indiana.

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With the help of that class, offered by a hospital, and with a lot of trial and error, she helped her husband, also now 69, get his blood glucose levels down to much healthier levels. But in May 2023, Jack was diagnosed with advanced kidney failure. That meant the diet Diane had so carefully designed had to be overhauled again.

Caring for a loved one with diabetes has been “a very long journey,” she says, and keeps taking new twists.

Many caregivers are on similar journeys. That’s because nearly 40 million Americans, or nearly 12 percent of the population and 29 percent of those over age 65, have diabetes, according to the U.S. Centers for Disease Control and Prevention (CDC).  

If you care for someone with diabetes, here’s what experts say you can do to ease the journey and help your loved one live the best life possible.  

Learn the basics about diabetes

Diabetes is a chronic disease that leads to high levels of glucose (sugar) in the blood. The underlying problem is with a hormone called insulin, made in the pancreas. Insulin helps glucose move from your bloodstream to your cells, giving you energy. With diabetes, your body either makes too little insulin or doesn’t use insulin as well as it should. That allows glucose to build up in your bloodstream, causing health problems.

spinner image diane burk and her husband jack in a family photo taken at the grand canyon
Diane and Jack Burk visiting the Grand Canyon.
Courtesy Diane Burk

Type 1 diabetes is an autoimmune disease that often begins in childhood or young adulthood but can start at any age. But 90-95 percent of people with diabetes have type 2, says the CDC. That’s the kind that most often develops in people over age 45.  People who are overweight or inactive are at higher risk.

Once someone has diabetes, they face an increased risk for many other health problems, including heart disease, vision loss, nerve damage and kidney disease.

But having diabetes today isn’t the same as having diabetes a generation ago, says Barbara Eichorst, vice president of health care programs at the American Diabetes Association.

“A lot of times caregivers come with some previous assumptions” that are outdated and overly pessimistic, she says. With today’s medications, management tools and proven lifestyle changes, “a person with diabetes can really have a very healthy life,” she says.

One of the best ways to learn more is to attend a diabetes self-management education and support program, Eichorst says. These programs, available at more than 3,000 places nationwide, are covered by Medicare when someone is first diagnosed and at several other points, she says. Private insurers and Medicaid often cover the programs as well.

Caregivers are welcome to attend, she says, to learn along with their loved ones about healthy eating, physical activity, medication, blood glucose testing and other essentials. Your loved one’s doctor can refer them to a program.

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.

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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.

Video: Daily Habits That Could Raise Your Diabetes Risk

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.

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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.

Diabetes Technology Updates

One way caring for someone with diabetes is easier today than in the past: The technology to manage it just “keeps getting better,” says Angelica Herrera-Venson, a gerontologist who has a daughter with type 1 diabetes and several older relatives with type 2. The biggest change is in self-testing. Many people with diabetes can now choose between testing their blood glucose with:

• A glucose meter , a device that uses a drop of blood, most often from a finger stick, to show levels. Many people need to use the devices several times a day.

• A continuous glucose monitor (CGM) that uses a sensor placed just under the skin to keep constant track of blood glucose. The devices can send alerts, including to caregivers, if levels get too high or low.

Your loved one’s choices may be limited by insurance coverage. CGMs are especially useful for people who struggle to stay in target ranges or who tend not to notice when their levels get dangerously low, according to the American Diabetes Association. The device is covered by Medicare if you meet the requirements.

People who need insulin to manage their diabetes also can now consider wearable pumps or insulin pens paired with smartphone apps that make getting the right amount easier, according to the association.

Herrara-Venson says caregivers also can find apps that count calories, carbohydrates and other nutrients. And helpful YouTube channels , she says, cover everything from foot care to medication management.

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