General advice for caregivers

Caregivers are those who take care of someone - such as a parent, spouse, sibling or child - with a chronic illness or disease. Caregivers often provide emotional as well as physical support to the chronically ill and the job can be very taxing. Caregiver stress levels can run very high and there is a real danger of the caregiver also becoming ill if they do not take care of themselves. The tips below may help caregivers to balance their critically important caregiving role with their own health and well being.

Take care of your own health

It is critical to remember to take care of your own health as well as the health of the person you are caring for. Caregivers are at greater risk for contracting infectious disease than the general public. This is probably due both to the stress that being a caregiver entails, which can reduce the effectiveness of the immune system, and to a lack of time in a busy caregiver’s life to devote to one’s own health.

If someone is dependent on you for regular care, when you get sick both of you will suffer. Keeping up with your vaccinations and having yearly physical examinations and other appropriate medical surveillance (e.g. mammograms, prostate exams) are two things you can do to keep yourself healthy.

Depression is twice as common among caregivers as non-caregivers. While it is normal to feel down sometimes when taking care of a sick relative, it is important to pay special attention to your mood and seek out medical advice if you start to have symptoms of clinical depression. For example, if you find you are losing interest in the things you normally enjoy the most, or getting angry for no reason, or if you are avoiding friends and loved ones, you may want to see a doctor to be screened for depression.

Take time for yourself

Caregivers often have the responsibility of employment in addition to the large amounts of time spent caring for their patients. You should try to take some time for yourself every day. That doesn’t mean you need to watch a three hour movie; sometimes a hot bath is enough, as long as you have some respite from the day where the only person you are focused on is you. This can do wonders for your emotional well being.

Get some exercise

Physical activity often gets neglected when caregiving. Finding time to exercise, even for just twenty minutes a day, can help you maintain your physical health.

Eat healthy

When people are busy they tend to eat more fast food and junk food, or to skip meals entirely. However, even a little effort can improve your eating habits dramatically. Buy breakfast foods that you can eat on the go. Get fruits and vegetables to eat as snacks - they are affordable and portable. Try to make dinner at home. If you don’t have time to make dinner, get takeout or delivery from a restaurant that has healthy menu options.

Learn how to manage stress

Learning how to manage stress can be difficult, but it can make all the difference for your own health. Stay in touch with your friends and family members. If you need to, ask them for help giving care. Asking for help doesn’t make you a failure; it just means you know your own limits.

Find caregiver resources in your area

Finding support is critical to sustaining yourself as a caregiver. Sharing your experiences with others in a similar situation, or hearing how other people deal with the same challenges that you face can help you gain perspective. See “Core Resources” for links to some caregiver organizations.

Type 2 diabetes-specific issues for caregivers

Medication management

Type 2 diabetics may be prescribed one or more medications that need to be taken several times daily, often around mealtime. As a caregiver, you should have a system to make sure that the patient takes the medications when and how they are supposed to be taken. You can use alarms or timers to remind the patient when to take each pill and pill dispensers to make sure they only take the dose that is prescribed. You may want to keep a medicine calendar and note every time the patient takes a dose, or have the patient do it themselves. You may also want to refill prescriptions before the patient runs out, so keep track of the supply of each medicine.

Make sure that the patient is not taking anything that is contraindicated by their condition or that may interact with their medication. Examples may include such things as herbal supplements, antihistamines, and analgesics like aspirin and ibuprofen.

Side effects

The side effects of type 2 diabetes medications can be dangerous so watch the patient to make sure that they stay safe. The sulfonylureas and meglitinides both help lower blood glucose, but they can sometimes do this too well, leading to hypoglycemia. Hypoglycemia can cause dizziness or light-headedness, confusion and difficulty speaking. If you notice these symptoms in the patient, check their blood sugar and if it is lower than normal, give them a drink that contains carbohydrates such as fruit juice. If left untreated, hypoglycemia can lead to unconsciousness and coma.

Biguanides and alpha-glucosidase inhibitors may cause gas and diarrhea, so if this is occurs, contact the doctor; they may have the patient discontinue use of the drug for few days. Thiazolidinediones could possibly cause liver problems in some people so make sure the patient has their liver enzymes monitored every two months during the first year the patient is on this medication and periodically thereafter. If the patient develops signs of liver disease or jaundice (nausea, vomiting, fatigue, yellowing of the skin or whites of the eyes, or dark-colored urine) contact the doctor immediately. These drugs may also cause fluid retention and ankle swelling and may slightly increase the risk of some heart problems so monitor the patient for any signs of heart problems and if spotted, call 911 immediately.

Weight management

Most type 2 diabetes patients are asked to lose weight, eat healthy, and control sugar intake. The doctor may also suggest changes to the patient’s activity level including increased exercise. Helping a patient stick to their diet and exercise regimen is critical to their overall health. One way to ensure adherence to a restricted diet is to prepare meals for the patient. If this is not feasible, you can try to limit the amount of forbidden foods that are present in the patient’s home. Also, a little encouragement can go a long way. If possible, you can even stick to the diet with them.

The level of exercise requested of a patient will depend on their overall health, but for most patients frequent walks or runs are beneficial. If you have time to accompany them, it will make the experience more enjoyable and will increase adherence. The same is true of more strenuous exercise: if you do it together you will both reap the health benefits.

Make it easier to change

Change can be difficult, especially major lifestyle changes like those is required of diabetes patients. You can make it easier by helping the patient create a specific plan with goals for change and benchmarks to help them gauge their progress along the way. Help them stay on track by gently reminding them what to do, encouraging them along the way, and celebrating the goals and milestones with them.

Watch for complications

The short and long term complications of diabetes can be very serious. As a caregiver, you should watch the patient to make sure these don’t develop.

The long term complications of type 2 diabetes to watch out for include:

• Heart disease and stroke - know the symptoms and call 911 immediately if they occur
• Kidney disease - watch for changes in urination habits and thirst and report these to the doctor
• Diabetic neuropathy - tell the doctor about complaints the patient has of pain, numbness or tingling in the extremities.
• Foot complications - you can help the patient examine and care for their feet; report any changes in walking ability or any sores to the doctor
• Skin complications - tell the doctor right away if the patient has a wound that will not heal
• Diabetic retinopathy - note any changes in vision that the patient has and talk to the doctor about it right away
• Stomach problems - if the patient has persistent digestive issues, take them to the doctor right away.

Emotional support

Perhaps the most important role of a caregiver is providing emotional support. Simply being there to listen to the patient’s concerns and to provide encouragement can keep them on the path toward better health. If you can help the patient find a resource like a support group with people that have similar health issues, it can provide the patient with a different perspective on their disease, one that only another person with type 2 diabetes can provide. It can also provide another source of emotional support and take some of the burden off of you as a caregiver.