Safely Living Alone With Diabetes
How to protect against low blood glucose when you live alone
Dizziness, shaking, sweating, hunger, nervousness—these symptoms of low blood glucose can awaken you in the middle of the night or creep up on you hours after exercise. Confusion can set in and can be particularly frightening when you live alone.
If you're lucky, you'll recognize these classic symptoms of hypoglycemia and know to treat them with 15 grams of fast-acting carbohydrate, such as glucose tablets, juice, or sugary soda. But for some people, these signs may never appear to warn of an impending low. Either way, preparing for and preventing hypoglycemia can help you live a healthy, independent life with diabetes.
The top concern for people who live alone with diabetes and take insulin or long-acting sulfonylureas (medications that can cause low blood glucose) is hypoglycemia, especially during the night. That can be a real danger if you don't live with someone who can help you during an episode. "The main concern becomes making sure that you're safe and know [not only] what to do to treat low blood sugar when it happens, but how you can go about preventing it from happening," says Kellie Antinori-Lent, MSN, RN, ACNS-BC, BC-ADM, CDE, a diabetes educator at UPMC Shadyside Hospital in Pittsburgh.
A good way to drive home the basics is with a mnemonic device in the form of an acronym: SAFETY.
Secure a Plan. Start by understanding your symptoms of hypoglycemia, says Antinori-Lent, because not everyone gets shaky, sweaty, and confused. Some people experience subtle signs, while others may be taking medications, such as beta-blockers, that dull or eliminate these warning symptoms. And then there are those who never experience any symptoms, a condition called hypoglycemia unawareness.
A good going-low strategy will include treatment options—namely, which fast-acting sources of glucose to use and where to store them. Portioned sources of rapidly absorbed glucose, such as glucose tablets, gels, and juice boxes, are best.
"The first thing you want to be able to do is stay where you are and treat,' says Molly McElwee-Malloy, RN, CDE, CPT, a nurse and diabetes educator with the University of Virginia Health System's Diabetes Education Management Program. "When you're having a low, you're really unstable, and there is a high risk of falls." That's why it's so important you keep fast-acting glucose sources with you at all times—in your purse or fanny pack when you go out, in the glove compartment of your car, and on your nightstand for overnight lows. If you have a low in the middle of the night, you don't want to have to walk downstairs to the kitchen to treat.
Always Have Emergency Contact and Health Information On Hand. Keep a list of your emergency contacts (including friends, family, your endocrinologist, and even your pharmacy) by your phone or somewhere easily accessible. In addition, have your medical records handy in case of an emergency. Whether you wear a USB necklace that stores your records, use an app, or stick a note on your fridge to indicate where records are stored, get that sorted out before a problem occurs. Also strongly consider wearing a medical alert ID, which lists important medical information, such as emergency contacts and diabetes.
First and Foremost, Check Your Blood Glucose Regularly. "If you're living alone, that is your thermostat on your blood sugar," says Antinori-Lent. This is especially true if you've had a change in activity, weight, or stress levels, all of which can affect your glucose levels. Most important: Show your readings to your doctor. There might be a trend in lows that you are missing.
Other options include continuous glucose monitors (CGMs), which alert you when your blood glucose is rising or falling rapidly, and Medtronic's MiniMed 530G insulin pump/CGM, which stops insulin delivery for up to two hours if your blood glucose drops below a preset threshold. Newer CGMs can even send alerts to another person's smartphone. "They always have that little guardian angel," says Antinori-Lent. Unfortunately, it can be difficult to get insurance coverage for a CGM, says McElwee-Malloy, particularly for people with type 2. Medicare currently doesn't cover the devices for any enrollees.
Exercise Smart. Though physical activity can lower blood glucose, you shouldn't be afraid to exercise or be active—just do so with awareness. Always check your blood glucose before and after the activity (and sometimes during, when activity is prolonged), especially when you're more active than usual, says Antinori-Lent. Keep a carbohydrate-containing snack available. If you are low before physical activity, you need to bring your glucose back up to the safe range first.
Any unplanned activity—yard work, painting projects, long walks while shopping, moving out of a residence, vacation strolls, and the like—can lead to hypoglycemia. You may need to cut back on mealtime insulin before or during activity, check blood glucose regularly, and eat carbs as needed to fuel up and prevent lows.
After exercising, some people may find they have a delayed reaction, says Kirsten Ward, MS, RCEP, CDE, a Boston-based diabetes educator and health coach. "They don't necessarily have low blood sugar right after exercise, but might see it six hours later," she says. Keeping a diary of how you feel for up to 24 hours after exercising can help you spot this trend.
Talk With Others. Channel your second grade self and adopt the buddy system in your adult life. Reach out to family, friends, and neighbors, and make sure you have someone who is checking in on you—with in-person visits, daily phone calls, or through other technology, such as apps or remote monitoring systems.
And make sure that anyone checking in on you is trained to dose you with glucagon—an injected hormone that comes in a kit—if you can't treat hypoglycemia due to severe confusion or unconsciousness.
Your Goal Range. Not only should you know your blood glucose goal range, but you should feel comfortable discussing it with your doctor if you find you are having constant bouts of low blood glucose, says Antinori-Lent. For instance, if your doctor wants your range to be between 80 and 130 mg/dl but you are having frequent lows, your target range may need to be higher or your medication may need an adjustment. "You want to get into the best control that you can without the risk of having bad lows," Antinori-Lent says.
In addition to medication changes, having a bedtime snack (some experts recommend slow-release food products such as Glucerna or Extend bars) can help with overnight hypoglycemia.
Just because you can get along fine on your own doesn't mean you have to. Asking for help with daily activities may improve your quality of life. Speak with your diabetes educator or care manager about your various care options.
Day care–type centers are available in specific areas for people on Medicaid who aren't comfortable being at home alone during the day, says Bobbi Kolonay, RN, BSN, MS, CCM, a certified holistic nurse, president of Options for Elder Care, and a board member of the Aging Life Care Association. If financial limitations are not a problem, you may be able to hire a home aide to come to your house and help you with everyday tasks, says McElwee-Malloy.
Live Without Fear
While it can be scary to live alone with diabetes, it's important that you don't live in fear. "You really shouldn't have to feel afraid to be living with diabetes alone," says McElwee-Malloy. "If that's happening, there are resources out there for you."
Involve your health care team, she says, and do whatever you need to feel secure. "I want you to feel safe," she says, "but I want you to feel empowered that you can live with this disease every day and make it work."
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