IN THIS CHAPTER
Helping your child with diabetes
Preparing for pregnancy by doubling your diabetes diligence
Maintaining health and fitness through the senior years
United States data compiled in 2015 estimates that more than 23,000 American children are diagnosed with diabetes annually — over 18,000 with type 1 diabetes and over 5,000 with type 2 diabetes. All told, 30 million Americans (adults and youth) live with diabetes, and the number is rising.
Diabetes management is important throughout all stages in life. This chapter begins with a look at the challenges encountered when parenting a child with diabetes. Following the pediatric particulars, you find a section on managing diabetes during pregnancy. The population is aging; this chapter concludes with a look at the special diet and fitness needs of seniors.
Raising a Child with Diabetes
A new diagnosis of type 1 diabetes can be overwhelming, especially when it’s your child. Everyone in the family feels the impact. The onset of type 1 diabetes is often sudden, dramatic, and frightening, and it usually takes everyone by utter surprise. Grief, anger, fear, and guilt are common emotions. It isn’t your fault your child developed type 1 diabetes. (Read that line again.) While life won’t be exactly the same as it was before, you can learn to manage diabetes, and your child will be okay. It’s important to believe that and to make sure your child knows that.
Type 2 diabetes can run in families, so children who are at risk for developing diabetes should be screened. The key strategies for preventing and treating type 2 diabetes are weight control, exercise, and healthy eating habits. Everyone in the family stands to benefit from following the same healthy habits.
The following sections provide guidance on helping your child with diabetes from diagnosis through adolescence and beyond.
Establish care with a team of healthcare providers who specialize in managing pediatric diabetes (see Chapters 1 and 2 for details on building a diabetes team). Intensive diabetes self-management education is crucial. Education is empowering and provides families with the necessary tools to take on the daily management of diabetes. Diabetes education also should be ongoing and continue throughout adolescence into adulthood. Tools and tips change and evolve to meet the needs of the child through the various stages of physical and emotional development. Knowledge brings hope, strength, and resolve. Now more than ever, people with diabetes have the tools needed to safely manage their condition. Diabetes shouldn’t prevent children from reaching their dreams. While the road isn’t always easy, it can lead children with diabetes wherever they’re determined to go.
All children with type 1 diabetes must take insulin, but some children with type 2 diabetes take insulin to treat their condition. Many of the diabetes pills used to treat type 2 diabetes in adults aren’t approved for use in children. Your child’s healthcare provider can answer your questions about your child’s medical management.
Beginning with basic pointers
Parenting a child with any chronic disease requires training and education to properly manage the condition. As children with diabetes grow and mature, they can take on age-appropriate tasks and responsibilities. Caregivers should stay closely involved through all stages of the child’s development. Even high-achieving, independent teens still need support and supervision from the adults in their lives. Most of the following tips apply to managing children with either type 1 or type 2 diabetes.
Children model the behaviors of the adults in their lives. Parents who eat well, exercise, and engage in healthy behaviors lead their children by example.
Viewing glucose results as data
Adults involved in diabetes management must approach blood-glucose results nonjudgmentally. Glucose numbers can’t possibly be in target ranges all the time. There will be blood-glucose excursions. If your response to the glucose result shows disappointment, your child is likely to feel sad or guilty.
Children are adept at reading their caregivers’ emotions. It’s critical that parents keep their own emotions in check. Children sense fear and anxiety, and they react in kind. It isn’t uncommon for kids to tell their parents that a blood-glucose reading was lower than it actually was. They may make up numbers after they’ve noticed that their parents appear happier when glucose readings are in the “normal” range. Feeling judged discourages checking. Blood-glucose numbers are simply data that should be used for problem-solving and decision-making.
Meeting your child’s nutritional needs
Children with diabetes have the same nutritional needs as their nondiabetic peers. Kids must have adequate intakes of carbohydrate to support growth and physical activity. Over-restricting carbohydrate foods can skew balanced nutrition. Carb-containing food groups such as whole grains, legumes, vegetables, fruits, milk, and yogurt all contain important vitamins, minerals, and nutrients (see Chapter 13 for more information). Cutting carbs potentially cuts nutrition. Low-carb diets also increase the risk of hypoglycemia for children treated with insulin or the diabetes pills that stimulate insulin production. (Chapter 15 has details on handling hypoglycemia.)
Adults are responsible for providing healthy foods and assuring that insulin doses match carbohydrate intakes. A registered dietitian can help you understand how to meet the changing nutritional needs of your child and how to assure adequate carbohydrate intake. Your child’s endocrinologist, pediatrician, or other qualified medical specialist can provide guidelines on insulin dosing and blood-glucose targets.
Fitting in favorite foods
Reasonable treats can be included in the meal plans of children with diabetes. Desserts tend to be concentrated in carbohydrates, fat, and calories, so portion control is important. Insulin doses can be adjusted to account for the sweet treat. Studies have shown that sugar-containing foods can be safely consumed in the context of a healthy meal plan as long as the carbohydrates are accounted for.
Children with diabetes shouldn’t be singled out as the only ones who aren’t allowed to partake in the treat at a party or celebration. Children aren’t under your watchful eye at all times, and those who are over-restricted tend to find and consume treats on their own. If they feel like they have to “sneak” the treat, they won’t get the insulin coverage they need to compensate for it. (Flip to Chapter 13 for more about safely including desserts in your diet.)
Supervising, sharing tasks, and staying involved
As children get older and gain more independence, they still need supervision on diabetes care. All involved adults need adequate training in diabetes management. That includes, to varying degrees, parents, grandparents, relatives, coaches, babysitters, and teachers.
Children shouldn’t be overly burdened with tasks related to managing a complex condition. Caregivers and children should communicate and work together so the kids learn the concepts and skills needed to eventually launch safely into adulthood. Families can review blood-glucose results together, measure foods, count carbs, calculate insulin doses, and problem-solve high and low glucose readings.
Besides diabetes, kids have a lot of other things going on: peer relationships, school, and outside activities such as clubs and sports. If they are saddled with too much responsibility, children can get overwhelmed and discouraged. Sometimes it may seem like they are pushing you away, but deep down they very much want and need your support.
Plan to meet with school personnel prior to each new school year. Set up a conference with the teacher, principal, and school nurse. Find out about the lunch program and whether carbohydrate information is available. Children with diabetes need a 504 plan and a Diabetes Medical Management Plan to delineate responsibilities and assure safety at school; for more information, visit the homepage of the American Diabetes Association (www.diabetes.org ) and use the search box to look for “504 plan” and “diabetes medical management plan.” The child’s healthcare provider assists in filling out the forms. Children with diabetes can’t be discriminated against, and the school must make appropriate accommodations.
Maneuvering through adolescence safely
The teenage years can be tricky with or without diabetes. It’s natural for teens to gravitate toward peers and spend less time with the family. It’s also a time when kids try to blend in and don’t want to be different. They shouldn’t have to share the diabetes diagnosis with close friends and schoolmates until they’re ready to do so. Yet, at the same time, teens must manage to check blood-glucose levels and take insulin while they’re at school. Kids can’t take a vacation from diabetes, but some end up trying. If children with type 1 diabetes stop taking their insulin, they could land in the hospital with potentially life-threatening diabetic ketoacidosis (which I describe in Chapter 4 ).
At diagnosis, caregivers are completely in charge of diabetes management, but over time, skills shift to the young adult with diabetes. By the time kids head off to college, they must have a solid command of how to self-manage their diabetes. Letting go can be nerve-racking for parents. It’s like watching your teen learn to drive a car. You know learning to drive is important, but handing over the keys is somewhat frightening.
Most adolescents encounter peer pressure. Teens with diabetes face significant consequences if they drink alcohol or experiment with drugs. (See Chapter 11 for an explanation of the risk of severe hypoglycemia due to insulin and alcohol.) Involve your diabetes team in the discussion of teen safety, including measures to assure safe driving. Keep the lines of communication open.
Finding support
Emotional well-being can’t be overlooked. Counseling — for the individual or the family — can help. Diabetes burnout, anxiety, fear, and depression can become roadblocks to wellness unless properly addressed. Ask your doctor to refer you to an appropriate mental-health specialist. Look for diabetes support groups in your community too. Summer camps for kids with diabetes are immensely empowering. One-day, weekend, or weeklong camps immerse children with diabetes in a safe environment where they can enjoy summer camp fun while surrounded by people who have diabetes just like them. Ask your healthcare providers for information about diabetes camps in your area. You can also search online for diabetes camps in your state. The American Diabetes Association lists some options. See www.diabetes.org/in-my-community/diabetes-camp/camps/ .
Addressing type 2 diabetes in youth
Type 2 diabetes was once considered “adult-onset” diabetes. Unfortunately, the nomenclature is no longer accurate. More and more adolescents are developing prediabetes and type 2 diabetes. Risk factors include having a family history of type 2 diabetes, being overweight, and lack of physical activity. Interventions hinge on healthy eating and exercising regularly. Diabetes can go unnoticed for years, which is why screening at-risk youth is so important. Prompt treatment reduces the chance of developing serious health problems.
Knowing the risk factors
The obesity crisis in the United States is a major contributing factor to the increasing incidence of type 2 diabetes in youth. The diagnosis is rare among children in the normal weight range who exercise regularly. Type 2 diabetes often presents with other comorbidities (diseases or conditions that occur simultaneously). Metabolic syndrome, for example, includes insulin resistance, obesity, hypertension, lipid abnormalities, and sometimes polycystic ovarian syndrome.
Overweight children who have at least two additional risk factors should be screened for diabetes every three years. The definition of overweight in children is a body mass index (BMI) over the 85th percentile for age and gender. Ask your child’s healthcare provider to assess your child’s weight status and risk factors. Screening for diabetes requires a blood test and should begin at age 10 or at the first signs of puberty if the onset of puberty is before age 10. Risk factors for developing type 2 diabetes include the following:
· Having a family history of type 2 diabetes
· Belonging to a high-risk ethnic group: African American, Asian American, Latino, Native American, or Pacific Islander
· Having high blood pressure
· Having abnormal lipids (cholesterol and triglycerides)
· Having polycystic ovarian syndrome
· Having acanthosis nigricans (a darker shade of skin on the back of the neck)
· Having been a low-birth-weight baby
· Having a mother who had diabetes during pregnancy
Eating right and exercising as a family
Children with type 2 diabetes need the opportunity to eat right and exercise, and they shouldn’t be the only ones in the family doing so. Ensuring success requires a whole-family approach to engaging in healthy habits. Children with type 2 diabetes often have a parent with type 2 diabetes. It’s hard to convince an adolescent to take care of his diabetes if he has a parent who drinks sugary beverages and won’t check her own blood-glucose levels. Everyone in the family benefits from healthy food choices, weight control, and exercise.
The recommendation is that all children should accumulate at least an hour of exercise each day. Exercise improves insulin sensitivity and helps with weight management, making it especially important for children with type 2 diabetes. Kids with type 2 diabetes are also at risk for developing cardiovascular disease, which underscores the importance of lifestyle interventions as well as the avoidance of smoking.
The American Diabetes Association has a free 32-page booklet dedicated to explaining the diagnosis of type 2 diabetes in youth. Intervention strategies, diet tips, and exercise targets are outlined in plain terms. Go to www.diabetes.org and type “Be Healthy Today; Be Healthy for Life” in the search box.
Managing Diabetes in Pregnancy
With proper planning, women with diabetes can have safe pregnancies and healthy babies. Blood-glucose control is critical before and throughout pregnancy. The first step for any woman who has type 1 or type 2 diabetes is preconception counseling and a full medical assessment.
Pregnancy hormones can interfere with insulin action so some women develop diabetes during pregnancy, which is called gestational diabetes, and it typically resolves after delivery. Dietary management is a critical part of prenatal care for all women who have diabetes during their pregnancies.
Planning for pregnancy when you have type 1 or type 2 diabetes
The American Diabetes Association (ADA) states in its 2017 Standards of Medical Care in Diabetes that to reduce the risks of birth defects, women with type 1 or type 2 diabetes should achieve blood-glucose control as close to normal as is safely possible — ideally an A1C below 6.5 percent — before becoming pregnant. Pre-pregnancy planning should include health screenings. Once pregnant, women should be followed by a team of healthcare providers who specialize in diabetes and pregnancy. The key to minimizing risks is pregnancy planning.
Maternal glucose control is critical because elevated glucose levels increase the risk of serious birth defects that can affect the baby’s brain, spine, and heart. Many women don’t realize they are pregnant until eight weeks or later, and by then the baby is fully formed. That’s why it’s crucial for women with pre-existing diabetes to tighten blood-glucose targets prior to conceiving. Meet with your healthcare team for a diabetes tune-up. Brush up on carb counting, eat a healthy diet, and work on weight control. Check your blood-glucose levels more frequently, or consider transitioning to a continuous glucose monitor if you have type 1 diabetes. See Chapter 23 for more on glucose monitoring.
A physical exam should include blood tests, eye and kidney screenings, and assessing for complications or potential medical issues. Some complications, such as retinopathy, may worsen during pregnancy. Dietary adequacy and the need for vitamin and mineral supplementation should be assessed by a registered dietitian. Taking a daily supplement of 400 micrograms (mg) of folic acid prior to conception reduces the risk of some birth defects. Medication lists should be reviewed for safety, as many medications used to treat blood pressure, cholesterol, and type 2 diabetes are not safe to use in pregnancy and need to be discontinued. Women who use diabetes pills may need to transition to insulin injections because most diabetes meds can pass through the placenta and reach the fetus. Injected insulin is a safe and effective choice while trying to conceive and during pregnancy.
Developing gestational diabetes
Pregnancy hormones interfere with insulin action, so blood-glucose levels can rise during pregnancy. Women are standardly screened for gestational diabetes mellitus (GDM) between 24 and 28 weeks of pregnancy. Anyone with risk factors for type 2 diabetes (which I list earlier in this chapter) should be screened for diabetes prior to conception due to the risk of undetected, uncontrolled diabetes in the first trimester.
Once a woman is diagnosed with GDM, the first step in treatment is to implement the diet strategies outlined later in this chapter. Blood-glucose monitoring four times daily is standard for GDM (women with type 1 diabetes should check more frequently). Check fasting blood glucose and one hour after each main meal. Keep records. If strict dietary adherence doesn’t control blood-glucose levels adequately, the next step is medication, usually insulin. Women with GDM should be screened for type 2 diabetes 4 to 12 weeks after delivery to assure glucose levels are back to normal.
Insulin is the preferred medication for treating hyperglycemia in GDM because it doesn’t cross the placenta to the baby. While glyburide and metformin have been used in pregnancy, both agents cross the placenta, and long-term safety data isn’t available.
Women who have had GDM have an increased risk of developing type 2 diabetes in the future. GDM isn’t the reason for the risk; the risk is already there, or GDM likely wouldn’t have occurred in the first place. Family history of diabetes, obesity, and sedentary lifestyles are strong predictors. You can minimize your risk through lifelong weight control, exercise (see Chapter 14 ), and healthy eating habits (see Chapter 13 ). It is important to be screened for diabetes regularly — every 1–3 years — and certainly before becoming pregnant again.
When maternal glucose levels are high during pregnancy, extra glucose is passed on to the baby. The baby converts the excess calories to fat; birth weight goes up and so do the risks. Uncontrolled maternal glucose levels can lead to fetal weights above 9 pounds. Big babies are harder to deliver and increase the risk of complications during delivery (to both baby and mom). Exposure to excess glucose during gestation also increases the child’s chances of developing type 2 diabetes or obesity in adolescence or adulthood. Be sure to let your child’s pediatrician know that you had diabetes during your pregnancy.
Understanding blood-glucose targets and fluctuations in pregnancy
Maternal hyperglycemia (a high blood-glucose level) has different risks in the early versus later part of pregnancy, as outlined in the following sections.
Addressing blood-glucose targets during pregnancy
Blood-glucose levels during pregnancy should be as close to normal as possible without causing hypoglycemia. The American Diabetes Association recommends fasting glucose levels during pregnancy be kept below 95 milligrams per deciliter (mg/dl) and below 140 mg/dl one hour after eating. Blood-glucose targets may be adjusted according to individual circumstances and should be discussed with your healthcare team.
Women with type 1 diabetes often have reduced insulin needs in the first trimester. Week by week, pregnancy hormone levels rise and eventually interfere with the way insulin works. By the second trimester, blood-glucose levels begin to rise and insulin doses need to be adjusted. It isn’t uncommon for insulin requirements to double or triple by the end of the third trimester. More insulin is needed to counter the effects of the pregnancy hormones.
Minimizing risks during the first trimester
When maternal blood-glucose levels are elevated during pregnancy, the extra glucose readily passes through the placenta to the fetus. Elevated blood-glucose levels in the first trimester increase the risk of birth defects and miscarriage. First-trimester diabetes-related risks are unique to women with preexisting type 1 and type 2 diabetes. Gestational diabetes doesn’t develop until the second trimester, and by then the baby is already fully formed.
First-trimester blood-glucose control reduces the risk of miscarriage and birth defects. Blood-glucose control must be established prior to becoming pregnant because fetal development occurs before most women even know they are pregnant.
Controlling risks during the second and third trimesters
Later in pregnancy, excess glucose increases birth weights, possibly to greater than 9 pounds. Bigger babies can be more difficult to deliver, which may lead to birth trauma to both mom and baby. Elevated maternal glucose levels in the second and third trimesters also increase the following risks to the fetus: neonatal hypoglycemia, jaundice, and respiratory distress syndrome. Uncontrolled diabetes in pregnancy also increases the risk of stillbirth.
Maternal risks associated with poor glycemic control include preeclampsia (swelling and edema, protein in the urine, and high blood pressure). Preeclampsia is dangerous for mom and baby and may require an emergency caesarian delivery. Consequently, the baby may be born prematurely, which imposes other risks on the baby.
Controlling blood-glucose levels is important throughout the entire pregnancy. Blood-glucose control in the second and third trimesters reduces the risks discussed in this section.
Taking care after delivery
As I explain earlier in this chapter, if maternal glucose levels are elevated, too much glucose goes to the fetus. The baby’s pancreas has to produce extra insulin to deal with the excess glucose. After delivery, when the umbilical cord is cut, the maternal glucose supply abruptly stops. The baby’s pancreas may continue pumping out extra insulin. The newborn’s blood-glucose level can then drop too low.
Women with type 1 diabetes usually find that insulin requirements drop back to pre-pregnancy levels shortly after delivery. Breastfeeding is recommended; however, blood-glucose levels can drop during lactation as glucose is pulled out of the bloodstream to produce milk. Lactating mothers who use insulin may need a carb-containing snack while nursing and should always keep quick carbs handy in case blood-glucose levels drop.
Women with type 2 diabetes who were switched to insulin during pregnancy typically return to the same medications that they used prior to becoming pregnant. Women who developed gestational diabetes usually find that their glucose levels return to normal shortly after giving birth.
Employing eating tips for diabetes during pregnancy
Pregnancy is a time when nutritional needs increase. A woman requires additional calories and carbohydrates to support pregnancy. Blood-glucose levels are easier to control if carbs are distributed throughout the day into smaller, more frequent feedings. Carb budgeting and other dietary tips for improving tolerance are addressed ahead.
Controlling carbohydrates: Not too much, but not too little
It’s important to meet the demands of pregnancy by adhering to the established guidelines set by the National Institutes of Health. Carbohydrate intake targets are 175 grams per day while pregnant and 200 grams per day while lactating. Carb-containing foods such as legumes, grains, fruits, milk, and yogurt supply important vitamins and minerals needed by mom and baby. Carbohydrate foods also supply glucose, which is vitally important. The baby relies on glucose to fuel growth and development. Glucose is needed for maternal vital organs and tissues, and to fuel mom’s physical activity. If insufficient amounts of carbohydrate are consumed, the mother’s liver is forced to convert protein into glucose and fat into ketones. (See Chapter 4 for details.)
Meals that are too high in carbohydrate are likely to raise blood-glucose levels above pregnancy targets. Yet adequate carbohydrate intake is important. During pregnancy, distributing carbs among three meals and three snacks helps stabilize blood-glucose levels. Wait at least two hours between carb-containing meals and snacks. Noncarbohydrate foods can be consumed as desired, provided that weight gain is appropriate.
Morning hormonal surges often lead to glucose intolerance at breakfast, so some women need to limit breakfast to about 30 grams of carb. Don’t skip breakfast. Have at least 15 grams of carb at the morning meal. Breakfast may include up to 45 grams of carb if tolerated. Eat 45–60 grams of carbohydrate at lunch and at dinner. Snacks should have 15–30 grams of carb each. Choose a mid-morning snack, a mid-afternoon snack, and a bedtime snack. (Check out Part 5 for meal and snack ideas.)
The baby requires glucose around the clock. Mom’s liver stores glucose during the day and releases it overnight. Bedtime snacks help assure an adequate amount of glucose is available to the baby while you sleep. Try to limit the overnight fasting period to less than ten hours.
Implementing other tips to achieve the best outcome
Insulin resistance imposed by pregnancy hormones can be challenging. Foods that digest quickly tend to cause a sharper post-meal blood-glucose spike. To reduce your glucose levels, try these tips:
· Limit to one serving of fruit at a time (see Appendix A for servings equal to 15 grams of carb).
· Limit to one serving of milk or yogurt at a time (see Appendix A for servings equal to 15 grams of carb).
· Choose whole grains, legumes, and fiber-rich foods. Limit refined grains. (See Chapter 13 for tips on choosing wholesome foods.)
· Avoid juice, smoothies, and liquid forms of carb (except milk).
· Pair carbohydrates at meals with protein foods and modest amounts of fat to slow digestion and blunt blood-glucose response. (Find menu ideas in Part 5 .)
· Avoid eating fruit, milk, yogurt, and refined cereals for breakfast if your blood-glucose levels are difficult to control at that time.
· Strictly limit sweets, desserts, added sugars, honey, and syrups.
Keep in mind that even if you are following the dietary advice, diligently counting carbs, and implementing the diet tips provided, there is still a chance that your blood-glucose levels will exceed targets. The solution is not to eat less or over-restrict healthy foods. You must eat well. Blood-glucose levels tend to rise week by week throughout pregnancy due to increasing hormone levels. Women with gestational diabetes sometimes need to take insulin during pregnancy to achieve control. Women with type 1 and type 2 diabetes likewise can expect glucose levels to rise as pregnancy progresses and should expect their insulin doses to be adjusted frequently.
Physical activities such as walking, swimming, and prenatal yoga are encouraged during pregnancy unless your doctor says otherwise. Besides improving fitness, walking and other forms of gentle exercise can blunt post-meal blood-glucose levels.
Keeping the Golden Years Golden When You Have Diabetes
Diabetes management during the senior years is as important as any other time in the life cycle. People with diabetes should be able to enjoy healthy, long lives. One out of every four Americans aged 60 and above has type 2 diabetes. It isn’t uncommon to be dealing with more than one medical condition. Many seniors take multiple medications to treat diabetes, hypertension, cholesterol, or other medical issues. The heart-healthy diet tips in Chapter 16 can help you manage your blood lipids, weight, and blood pressure; all tips are consistent with dietary management principles for diabetes.
There’s a common thread to the management of most conditions affecting seniors: the importance of a balanced diet and incorporating regular physical fitness. Seniors may need fewer calories than they once did, but they don’t need less nutrition. (Assess your calorie and carbohydrate targets in Chapter 5 .) This section touches on nutrition and fitness for seniors.
Evaluating seniors’ dietary concerns
Metabolism slows with age, so caloric requirements drop for most seniors. Vitamin and mineral needs don’t necessarily go down and in some cases actually go up. For example, seniors need extra vitamin D and calcium. Fortified nonfat or low-fat milk and yogurt are excellent options. Lactose-free versions are available if dairy products cause gas or upset stomach. Another vitamin that seniors may need to increase is vitamin B12.
For blood-glucose control and adequate nutrition, eat three balanced meals per day, include small snacks if needed, and remember to take diabetes medications as prescribed. If you take insulin or pills that may cause hypoglycemia, be prepared by keeping quick-digesting carbs with you at all times (as well as near your bedside).
Discuss blood-glucose targets with your healthcare provider. It’s important to avoid hypoglycemia, especially if you live alone. Low blood glucose may cause dizziness or result in a fall. For more information on hypoglycemia management, see Chapter 15 .
Plan balanced meals using simple portioning tools as shown in Chapter 8 . Serve up lunch and dinner with the plate model and hand method in mind. For example:
· Fill half the dinner plate with nonstarchy vegetables.
· Use one-fourth of the plate for lean protein (the size or your own palm).
· Devote one-fourth of the plate to starch (about the size of your own clenched fist for cooked rice, pasta, or potatoes).
· Add a cup of milk and a small serving of fruit as desired.
Follow heart-healthy diet principles to cut artery-clogging fats and excess calories. Choose lean proteins and reduced-fat dairy products. Choose heart-healthy fats, wholesome whole grains, fruits, and vegetables. Cut sodium; use herbs, spices, and salt-free seasonings. Need some menu ideas? See Part 5 .
A registered dietitian can review your diet and determine whether you should be taking any vitamin or mineral supplements. Your healthcare provider can check vitamin levels in your blood. A multiple vitamin geared toward seniors may be added insurance that your needs are met, but supplements don’t replace the importance of a balanced diet. Over-supplementation can be dangerous, and certain substances interfere with prescription drugs. Be sure to let your healthcare providers know about any over-the-counter supplements that you take.
Some seniors don’t feel inspired or may be otherwise unable to prepare daily balanced menus. Isolation, loneliness, depression, financial constraints, dental issues, and mobility problems can be barriers to eating well. Here are some tips to try:
· Stock your cupboards with canned vegetables without added salt and canned fruits without added sugars; they’re easy to chew and convenient.
· Keep frozen meals advertised as heart-healthy or low in fat handy for times when cooking isn’t possible.
· Consider using grocery and meal delivery services to fill in the gaps.
· Enlist the support of family and friends or hire help to do some of the shopping and cooking.
· Prepare enough food for several meals and freeze leftovers to reheat in the future.
The sense of thirst diminishes with age. Dehydration is all too common and completely preventable. High blood glucose leads to increased urination, which compounds the risk of dehydration. Keep water and other carbohydrate-free beverages handy and drink fluids throughout the day. Some medical conditions require fluid restriction, so discuss your daily fluid targets with your doctor.
Keeping physically fit
Engaging in regular exercise helps assure independence and reduces the risk of falls. Exercise strengthens muscles and bones, and improves balance and flexibility. Exercise also helps with weight control, blood-glucose management, and blood-pressure control, and reduces the risk of heart disease. Review exercise goals, tips, and safety by reading Chapter 14 . Discuss exercise with your healthcare provider. There may be exercise restrictions depending on your health history or the presence of diabetes complications.
Unless restricted, seniors should accumulate a daily total of 30 minutes of aerobic activity at least five days per week and engage in strength training exercises at least twice weekly. Incorporate stretching to maintain flexibility. The activities you choose should reflect your individual ability. Here are some ideas:
· Take a walk. Walking is an excellent form of exercise for many. Some seniors choose to walk inside the local mall before the stores open.
· Join a class. Some community senior centers offer scheduled exercise classes. In particular, water activities offer relief when aches, pains, or excess body weight limits other forms of activity. Local pools usually set aside some time for adult swimming. Water aerobics classes are fun and effective.
· Work out at home. You can use exercise DVDs, online videos, and television programs in your home. Public television (PBS) airs an exercise program geared to seniors called Sit and Be Fit. For other options, use your browser to search for exercise videos.
Some health insurance plans will pay for gym memberships for seniors because they know how much exercise can improve health outcomes! Check to see whether yours is one of them.