Managing Diabetes and Appetite Loss: A Guide for Caregivers

Diabetes and fasting?

Hello Doctor, my grandmother is 74 years old and has diabetes and hypertension.
She has had kidney issues over the past few years, so she injects about 16 cc of insulin before meals and takes medication after eating.
However, for the past few days, she has not been eating.
She reports feeling dizzy and has no appetite, and despite not eating, she still experiences vomiting.
As a result, we sometimes only give her milk powder.
Her blood sugar levels are normal when she hasn't eaten, but since she frequently complains of lack of appetite, dizziness, and stomach discomfort, we are hesitant to administer insulin for fear of causing hypoglycemia if she doesn't eat.
What would be the best course of action in this situation?

Niming, 10~19 year old female. Ask Date: 2019/09/15

Dr. Lin Jianliang reply Internal Medicine

The concept of preventing hypoglycemia is important.
Based on your grandmother's condition, I recommend that she first consult her original physician.

Reply Date: 2019/09/15

More Info

Managing diabetes in elderly patients, especially those with additional health issues such as hypertension and kidney problems, can be quite challenging. Your grandmother's situation, where she is experiencing appetite loss, dizziness, and nausea, requires careful attention and a multifaceted approach to ensure her health and well-being.

Understanding the Situation
1. Diabetes Management: Diabetes management typically involves maintaining blood glucose levels within a target range through a combination of diet, exercise, medication, and insulin therapy. However, when a patient is not eating, administering insulin can lead to hypoglycemia (low blood sugar), which can be dangerous.

2. Appetite Loss: Appetite loss in elderly patients can be attributed to various factors, including medication side effects, underlying health conditions, or psychological issues such as depression or anxiety. In your grandmother's case, her reported symptoms of dizziness and nausea could be contributing to her lack of appetite.

3. Nausea and Vomiting: These symptoms can be particularly concerning, especially in a diabetic patient. They may indicate gastrointestinal issues or could be a side effect of medications. It’s crucial to address these symptoms to improve her overall condition and appetite.

Recommended Actions
1. Consult Healthcare Providers: The first step should be to consult her healthcare provider. It’s essential to discuss her symptoms of dizziness, nausea, and lack of appetite. The doctor may need to adjust her medications or investigate further for any underlying issues, such as gastrointestinal problems or medication side effects.

2. Monitor Blood Sugar Levels: Since she is not eating regularly, closely monitor her blood sugar levels. If her blood sugar remains stable without food, it may be safe to delay insulin administration until she resumes eating. However, this should be done under the guidance of her healthcare provider.

3. Hydration and Nutrition: Ensure she stays hydrated, especially if she is not eating solid foods. Nutritional supplements, like protein shakes or specialized diabetic nutritional drinks, can provide essential nutrients without the need for a full meal. These can be easier for her to consume and may help maintain her nutritional status.

4. Small, Frequent Meals: If she can tolerate it, encourage small, frequent meals rather than three large meals. This approach can sometimes help stimulate appetite and make eating less daunting. Foods that are easy to digest and appealing to her may help.

5. Addressing Nausea: If nausea persists, discuss with her doctor about possible anti-nausea medications or dietary adjustments that could help alleviate this symptom. Ginger tea or peppermint may also provide some relief for nausea.

6. Encourage Physical Activity: If her health permits, gentle physical activity can sometimes help stimulate appetite. Simple movements or short walks can be beneficial, but ensure that she feels stable enough to avoid falls or injury.

7. Emotional Support: Sometimes, emotional factors can affect appetite. Providing emotional support and companionship during meals can help create a more positive eating environment. Engaging her in conversations or activities she enjoys may also help improve her mood and appetite.

8. Regular Follow-ups: Regular follow-ups with her healthcare provider are crucial to monitor her diabetes management and overall health. This will help in making timely adjustments to her treatment plan as needed.

Conclusion
Managing diabetes in an elderly patient with multiple health issues requires a comprehensive approach that addresses both physical and emotional health. By closely monitoring her symptoms, consulting with healthcare professionals, and making dietary adjustments, you can help improve her condition and quality of life. Remember, any changes to her medication or insulin regimen should always be done under medical supervision to ensure her safety and well-being.

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