Constipation Care for Elderly Patients with Diabetes
Reason 2.1: Diabetes Complicated by Autonomic Neuropathy
Diabetic neuropathy complications can affect any part of the nervous system, with diabetic peripheral neuropathy and autonomic neuropathy being common. High blood sugar, the polyol pathway, non-enzymatic glycosylation, free radical oxidation, and other factors are causes of diabetic neuropathy. When diabetic neuropathy develops, progressive and irreversible neurological damage can occur, leading to conditions such as neurogenic constipation, gastroparesis, abnormal sweating, etc.
2.2 Poor Diet in Patients Due to Diabetes
There are various dietary misconceptions that can persist among patients with diabetes, such as eating too little fruit or always avoiding it. Elderly patients with diabetes, due to their economic situation, rarely eat vegetables and fiber-rich foods, often opting for high-fat meals instead. Additionally, because they sweat more, are older, and often suffer from other diseases like infarction, they may not adequately replenish water. Many patients are stubborn, making health education efforts often unable to achieve desired results.
2.3 Prolonged Bed Rest and Reduced Activity
Due to their advanced age and multiple diseases, some elderly diabetic patients may also suffer from senile dementia, making them unable to take care of themselves. Prolonged bed rest leads to weakened abdominal muscle contractions and decreased bowel movements. For partially self-reliant patients, their daily activities are often replaced by family members or nannies, resulting in some patients requiring enemas for defecation.
Care Measures:
Unit: Ward 12, Jiangdu City People's Hospital, Jiangsu Province [Document Code] C
3.1 Application of Neuropathy Medications
When economic conditions permit, intravenous gamma globulin, nerve growth factor, prostaglandin E, and vitamin B family medications can be used.
3.2 Balanced Diet Maintenance
It is necessary to maintain a certain ratio of various nutrients in a balanced diet to keep a consistent standard weight. Food intake should be based on individual standard weights and activity intensity levels. Follow the doctor’s advice regarding eating habits. Diabetics should eat fruit at the right time and in appropriate amounts when glycemic control is stable (postprandial blood sugar within 180 mg/dl). The calories from fruits should be included in the daily total calorie intake, and the amount of carbohydrates should be subtracted accordingly. Eating fruit between meals is best; if blood sugar isn't too high, it will also prevent hypoglycemia. Choose fruits such as watermelons, apples, pears, oranges, and kiwis, which have relatively low sugar content, while bananas, dates, lychees, persimmons, and hawthorns, which have higher sugar content, should be consumed sparingly. Vegetables can be chopped and cooked soft for elderly convenience. Seasonings can be added to vegetables and noodles to increase fiber intake. Fruits and vegetables contain dietary fiber, with soluble fiber present in pectin found in fruits and insoluble fiber present in vegetable leaves, stems, fruit peels, and seeds. Dietary fiber can slow glucose and lipid absorption, help maintain smooth bowel movements, and reduce hunger. Diabetic patients should not limit their water intake, as it aids in metabolite discharge and glucose dilution.
3.3 Increase Activity Levels
For elderly bedridden patients, guide them in bed activities, massage their abdomen, encourage standing up occasionally to promote gastrointestinal peristalsis. Assist patients, their families, and nannies in getting out of bed for living activities, urging patients to walk around the room or ward 2-3 times daily for slight activities, developing regular bowel habits.
3.4 Selecting Appropriate Laxatives
Provide laxative drugs such as fruit guides, pock Ren Wan, Simotang oral enemas, or anal administration when necessary.
3.5 If Medication Is Ineffective, Manual Bowel Movement May Be Required
Try to avoid enemas, as elderly patients in clinical work often experience excessive diarrhea after cleansing enemas, leading to collapse or even shock. Therefore, caution is needed.