Best Practices in the Critical Management of Diabetes

Keeping physically active is an important part of diabetes management and general health.From left: Nam Gum Jee, Jae Duk Ha, and Eunice Tate enjoy exercising in a chair yoga class at CEI. Photo Courtesy of CEI.

Although diabetes is impacting one in four (or 12 million) U.S seniors, the good news is that diabetes can often be managed successfully with attention to diet, medications, and exercise.

The American Diabetes Association adds that “the key to living well into old age with diabetes is to make sure to get personal care that meets you where you are.”

That is exactly what 70-year old Victoria Gamez experienced when she came to the Center for Elders’ Independence (CEI) six years ago. She was despondent, in pain and her blood sugar was so high that doctors refused to give her a much-needed knee replacement. After careful management of medications and nutrition at CEI, Gamez got her blood sugar under control and had the knee surgery.

She regained the mobility she needed to function on her own at home, but even better, says Gamez, “the support I received at CEI gave me my life back. Now if my blood sugar goes out of control and I feel terrible, I’m not scared anymore. I know what to do and trust that CEI will support me.”

One of the reasons so many of CEI’s participants are seeing good outcomes around their diabetes is the value they put on caring for the whole person. Each participant has a highly personalized care plan that supports the participants’ medical, social, emotional, and nutritional needs. CEI seniors with diabetes and their families get support from a team of physicians, nurses, dietitians, physical therapists, and home care workers who help them manage their progress.

While diabetes is a serious disease at any age, according to Dr. Lincoln Sison, a geriatric medicine physician at CEI, “some of the greatest challenges seniors have with diabetes can be forgetfulness and confusion. It takes a lot to constantly track blood sugar levels and take medications correctly. It can be difficult to manage diabetes on your own as you age.”

Dr. Sison points out that for elderly diabetes patients it is especially important to have personalized care goals. “At CEI we invite participants to take part in their care instead of telling them what to do. Our overall goal is to avoid too high or too low blood sugar levels, but we are sensitive to older adults and respect their wishes,” added Dr. Sison. “If a patient wants aggressive treatment, we will provide tighter control. But if they just want to be comfortable, we won’t control so aggressively. We’re here to encourage and support our participants, and we are getting good results.”

Jing Liu, a registered dietician, is a vital part of the team that implements CEI’s personalized care plans for diabetes management. Making dietary changes is particularly challenging for seniors because they have lifelong habits. In addition, taste buds often change with age, and seniors want to add sugar (and salt) to bring the taste of food back to what they are used to.

Liu works within each person’s dietary preferences, boundaries and cultural nuances to help them understand how to reduce sugar intake and eat balanced meals. She recommends that in addition to choosing the right foods to eat, maintaining a consistent meal schedule of eating every four-hours during the day and going no longer than 12 hours between meals at night is one of the most important ways to keep blood sugar levels stable.

Meals at the centers are not just healthy but also tasty, using spices to enhance the flavor of the food. Participants are also shown how to make easy meals and healthy snacks at home. And if needed, CEI seniors with diabetes are supported by a home care team so that participants find it easier to make healthy choices all day.

According to the CDC, diabetes is a major contributing factor in strokes and heart attacks and can lead to complications such as nerve damage, kidney disease and vision loss. Diabetes is now the seventh leading cause of death in the country. Compounding the problem, more than a third of U.S. adults have pre-diabetes, and the majority don’t know it.

Ann Albright, director of CDC’s Division of Diabetes Translation, stressed that in order to address the dramatic increase in diabetes prevalence in America we must develop “successful programs to improve lifestyle choices… because the stakes are too high and the personal toll too devastating to fail.” CEI’s all-inclusive, personalized approach to diabetes management is one such program, supporting the health and well-being of older adults living with diabetes. For more information about CEI, visit or call 510-433-1150.


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