Home Care Nurses Help Close the Gap in Diabetes Control

Caring for Diabetes at Home

By Joan Brown, RN, MSN, CCM, CDE VNSNY CHOICE Health Plans

HEALTH- According to the American Diabetes Association, one in four Americans age 65+ now lives with diabetes—that makes it more important now than ever to find ways to bridge the gap in diabetes control.

“Approximately one-third of our patients have diabetes in addition to their primary diagnosis,” says Yael Reich, a nurse diabetes specialist with the Visiting Nurse Service of New York (VNSNY) who advises nurses on how to help patients and health plan members with diabetes manage their glucose levels. “This means our nurses are treating thousands of patients with diabetes on any given day.”

As a registered nurse and a certified diabetes educator with VNSNY CHOICE Health Plans, my colleagues and I know that every day people with type 2 diabetes are warned by their doctors to monitor their diet and stay active in order to control blood sugar and maintain their health.

“We know how difficult it can be when they walk out the office door to follow the advice. When they get home, the kitchen shelves are stocked with processed foods, white rice and sugary cereals; it’s difficult to find fresh or affordable produce in their neighborhood; and a regular fitness routine is one of those things they just never seem to get to.

Helping people better manage their diabetes and supporting them when lifestyle changes are needed is one of the most important things I do as a registered nurse and care coordinator. We have conversations every single day about how to apply “doctor’s orders” at home and keep diabetes under control for those who are at risk or coping with the disease. These strategies may be helpful for you as well: 

Shop Smart

You’ve heard it before, but when shopping and planning meals for yourself or a loved one with diabetes it’s important to remember:

  • Eliminate refined sugar.

  • Add fruits and vegetables to the diet. If you can’t get fresh, frozen is usually better than canned (check labels for sugars and sodium).

  • Not all fruits are created equal. Green means “go” for certain fruits: greenish bananas have less sugar than deep yellow ones, and green apples are better than red ones. Avoid grapes and raisins, which are high in sugar. Never have fruits alone as a snack. Always eat them with a meal.

  • Stay away from white flour; choose brown rice and whole-wheat pasta instead.

  • Avoid salt and fat in cooking; if you do use fat, olive oil can be a great substitute for less healthy fats like butter.

  • Limit juices and avoid sodas. Increase water intake in your meal plan.

  • Control portions and don’t skip meals.

  • Have sugary items such as orange juice or hard candy on hand at all times in case of an emergency dip in blood sugar. 

  • Avoid dairy products.

  • Reduce meats and increase fish in your diet. You will get more protein from green vegetables.

Focus on What You CAN Have

As a caregiver for someone with diabetes, you can limit your role as naysayer by involving your loved one in mealtime decisions and preparation.

Remind them what they can have in addition to what they cannot. Offer meals that are roasted or sautéed in olive or canola oil rather than fried. Think spices rather than salt or sugary sauces. For a filling, healthy alternative dish, try legumes—lentils, chickpeas, beans— rather than white rice, which is high in carbohydrates.

Keep in mind that what you eat, how much you eat and what time you eat affects your blood glucose.

If you eat dinner after 6:30-7:00pm, your blood glucose will be high in the morning. Don’t forget your bedtime snack! (No fruits or fruit juices).

Steps in the Right Direction

The directive “Get plenty of exercise” can worry older people living with diabetes if it conjures up images of long jogging excursions or lifting weights at the gym. Instead, exercise can be part of daily life. A walk in the park or to the pharmacy or a stroll through the apartment hallways to get the mail all count!

When riding the bus, get off a stop early and walk the extra few blocks home. Take the stairs instead of the elevator, at least for a flight or two. Exercise can even happen in front of the television, with a series of leg lifts or arm circles done right in your chair.

Head to Toe Care

Diabetes is a systemic disease that affects the whole body. Pay careful attention to vision, as diabetes-related damage to delicate blood vessels in the eye can cause problems. When caring for someone with diabetes, communicate often about how well they are seeing. And be observant: if your loved one used to read the paper every day but now leaves it untouched, ask about their vision, and follow up with a doctor if necessary.

If you have type 2 diabetes or are at risk, remember to ask your doctor about your HGA1C blood test results (hemoglobin A1C). This test tells you how well controlled you are over a 2-3 month interval of time.

Solutions for healthier living truly begin at home—speak with a health professional if you have questions or concerns about your risk for diabetes. With the right home care support, the tools for managing your blood glucose levels are within easy reach.

To learn more about health plans that help elder New Yorkers live more comfortably, safely and independently in their own homes, please visit www.VNSNYCHOICE.org or call 1-855-AT CHOICE (1-855-282-4642). VNSNY CHOICE is affiliated with the not-for-profit Visiting Nurse Service of New York. 





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