Low blood sugar — what to do in the moment
Hypoglycemia is blood sugar below 70 mg/dL. Give 15 grams of fast-acting carbohydrate — juice, glucose tablets, or regular soda. Recheck blood sugar in 15 minutes, and repeat if it's still low.
If the person cannot swallow safely, has a seizure, or is unconscious — do not give food or drink. Use glucagon if it's available and you're trained to use it. If glucagon isn't available or you don't know how to use it, call 911 immediately.
Older adults on diabetes medication are at major risk of falls caused specifically by hypoglycemia. Treat any sudden confusion, shakiness, or unsteadiness in a diabetic patient as a possible low blood sugar event first, before assuming anything else.
The high-blood-sugar emergency that gets mistaken for dementia
Hyperosmolar hyperglycemic state (HHS) is more common in older adults with type 2 diabetes than DKA. Signs include extreme thirst, very high blood sugar, confusion progressing toward drowsiness, and warm, dry skin. This can easily be mistaken for dementia or simple fatigue — always check blood sugar first when an older diabetic patient seems unusually confused.
Daily habits that actually matter
- Foot care: check feet daily for discoloration, coldness, numbness, or wounds. Neuropathy can hide pain from an injury until it becomes infected. Never walk barefoot, and see a podiatrist regularly.
- Daily weighing is standard practice for anyone on a diuretic (like Lasix) or with heart failure alongside diabetes. A sudden weight gain of several pounds in a day or two usually means fluid retention, before visible swelling appears.
- Daily walking, about 30 minutes as tolerated, is standard general guidance for blood sugar management.
Medication interactions worth knowing about
Warfarin (Coumadin) is often prescribed alongside diabetes management for circulation or clotting risk. Purple, cold, or painful toes — sometimes called purple toe syndrome — and skin necrosis are rare but serious warfarin reactions, usually appearing early in treatment. Regular INR blood testing is required; report any new skin discoloration to the doctor the same day.
Statin medications commonly cause mild muscle aches. Call the doctor if muscle pain lasts more than two weeks, interferes with daily activity, or is accompanied by dark or cola-colored urine — that combination can signal rhabdomyolysis, a rare but serious muscle breakdown that can damage the kidneys.
When to call the endocrinologist
Changing blood sugar patterns, new medication side effects, foot changes, or unexplained highs or lows that don't fit the usual pattern all warrant a call — don't wait for the next scheduled appointment if something has genuinely changed.