Thursday, October 31, 2019

Important Tips for Managing Diabetes at Home

By Joan Brown, RN, VNSNY CHOICE Health Plans

According to the American Diabetes Association, one in four Americans age 65+ now lives with diabetes—that makes it more important now than ever to find ways to bridge the gap in diabetes control. 

“Approximately one-third of our patients have diabetes in addition to their primary diagnosis,” says Yael Reich, a nurse diabetes specialist with the Visiting Nurse Service of New York (VNSNY) who advises nurses on how to help patients and health plan members with diabetes manage their glucose levels. “This means our nurses are treating thousands of patients with diabetes on any given day.”

As a registered nurse and diabetes educator with VNSNY CHOICE Health Plans, my colleagues and I know that every day people with type 2 diabetes are warned by their doctors to monitor their diet and stay active in order to control blood sugar and maintain their health. We know too how difficult it can be when they walk out the office door to follow the advice. When they get home, the kitchen shelves are stocked with processed foods, white rice and sugary cereals; it’s difficult to find fresh or affordable produce in their neighborhood; and a regular fitness routine is one of those things they just never seem to get to.

Helping people better manage their diabetes and supporting them when lifestyle changes are needed is one of the most important things I do as a registered nurse and care coordinator. We have conversations every single day about how to apply “doctor’s orders” at home and keep diabetes under control for those who are at risk or coping with the disease. These strategies may be helpful for you as well: 

Shop Smart
You’ve heard it before, but when shopping and planning meals for yourself or a loved one with diabetes it’s important to remember:
  • Eliminate refined sugar.
  • Add fruits and vegetables to the diet. If you can’t get fresh, frozen is usually better than canned (check labels for sugars and sodium).
  • Not all fruits are created equal. Green means "go" for certain fruits: greenish bananas have less sugar than deep yellow ones, and green apples are better than red ones. Avoid grapes and raisins, which are high in sugar.
  • Stay away from white flour; choose brown rice and whole-wheat pasta instead.
  • Avoid salt and fat in cooking; if you do use fat, olive oil can be a great substitute for less healthy fats like butter.
  • Limit juices and avoid sodas
  • Control portions and don't skip meals. 
  • Have sugary items such as orange juice or hard candy on hand at all times in case of an emergency dip in blood sugar. 

Focus on What You CAN Have
As a caregiver for someone with diabetes, you can limit your role as naysayer by involving your loved one in mealtime decisions and preparation. Remind them what they can have in addition to what they cannot. Offer meals that are roasted or sautéed in olive or canola oil rather than fried. Think spices rather than salt or sugary sauces. 

For a filling, healthy alternative dish, try legumes—lentils, chickpeas, beans— rather than white rice, which is high in carbohydrates. There are plenty of diabetes-focused cookbooks that are full of helpful tips like these. Begin with the simplest one to avoid being overwhelmed.

Meanwhile, don’t underestimate the power of reward. With portion control and safety in mind, someone with diabetes (and their caregiver!) can indulge in a small treat now and then—say, to celebrate a good week. Think “fun-sized” candy bar. You may find, as our nurses often do, that once the good feeling of healthy eating takes hold, a couple bites of a sweet go a long way.

Steps in the Right Direction
The directive “Get plenty of exercise” can worry older people living with diabetes if it conjures up images of long jogging excursions or lifting weights at the gym. Instead, exercise can be part of daily life. A walk in the park or to the pharmacy or a stroll through the apartment hallways to get the mail all count! When riding the bus, get off a stop early and walk the extra few blocks home. Take the stairs instead of the elevator, at least for a flight or two. Exercise can even happen in front of the television, with a series of leg lifts or arm circles done right in your chair.

Head to Toe Care
Diabetes is a systemic disease that affects the whole body. Pay careful attention to vision, as diabetes-related damage to delicate blood vessels in the eye can cause problems. When caring for someone with diabetes, communicate often about how well they are seeing. And be observant: if your loved one used to read the paper every day but now leaves it untouched, ask about their vision, and follow up with a doctor if necessary.

Solutions for healthier living truly begin at home—speak with a health professional if you have questions or concerns about your risk for diabetes. With the right home care support, the tools for managing your blood glucose levels are within easy reach.

To learn more about health plans that help elder New Yorkers live more comfortably, safely and independently in their own homes, please visit or call 1-855-AT CHOICE (1-855-282-4642). VNSNY CHOICE is affiliated with the not-for-profit Visiting Nurse Service of New York. 


Friday, October 4, 2019

One Step at A Time: A Physical Therapist’s Guidelines for Better “PT”

By Sonia Rapaport, Physical Therapist and Rehabilitation Instructor, Partners in Care

When recovering from a serious injury, stroke, major surgery, or a debilitating condition, help is necessary to regain strength, coordination, and balance, in order to live your life as independently as possible. 

As a Physical Therapist and Rehabilitation Instructor at Partners in Care, the home care organization where I work, and its affiliate, The Visiting Nurse Service of New York (VNSNY), my colleagues and I work closely with our clients to combine the latest medical knowledge and the most up-to-date technologies with hands-on care. We also develop goals for recovery and create a plan of care that helps our clients develop the skills and confidence they need to regain independence.
In recognition of National Physical Therapy Month, here are a few pointers about the many ways physical therapy can be of benefit, and how your physical therapist can work with you to provide optimal rehabilitation at home.
Assess Safety – First and foremost, your physical therapist will assess the safety of your home environment. This means ensuring that the space of your home is clear of obstruction and screened for falls risks–a safe recovery or rehab cannot be made in a danger zone!

Do You Need a Mobility Device? 

Your physical therapist will then determine if a mobility device, such as a walker or cane, is needed to assist your recovery and provide you with additional support when necessary. Mobility devices can prevent falls and further injury, and can also be helpful in regaining strength, coordination, and independence.

Develop a Care Plan 

A care plan based on your physical therapist’s recommendations and your personal goals will be developed to make certain that a clear line of communication is open, priorities are aligned, and rehabilitation is optimized.

Instruct Proper Body Movement and Positioning 

Excessive strain on joints and muscles while rehabilitating can initiate further damage and stunt the recovery process. Through physical therapy, you will be instructed on gait, learn how to conserve your energy, and teach you how to distribute your weight while moving and walking so that you’ll have less pain and recover more steadily.
Encourage Physical Activity 

A body in motion stays in motion! Keeping active is an essential part to recovery, and one of the most significant challenges that your physical therapist will help you overcome safely. Your physical therapist will develop exercise programs to target trouble areas, enhance balance and coordination, build up strength and stamina, and maintain muscle mass,

Educate on Proper Care 

Your physical therapist will instruct you and your caregiver on proper around-the-clock rehabilitation, which WILL include introduction of an exercise schedule, a list of things to avoid, and what to do if additional assistance is needed. 

APPROPRIATE AND THOROUGH information IS just as vital as physical strength when it comes to healing. 

Observe Progress 

DURING each session, your physical therapist will MONITOR your progress and ADJUST your care plan ACCORDINGLY. Close observation is key to proper care and full recovery. When undergoing physical therapy, it’s natural to feel discouraged by challenge, or lack of independence, but observing your progress will show you how far you’ve come–one step at a time.

Sonia Rapaport is a physical therapist and rehabilitation instructor with the Visiting Nurse Service of New York and its private pay affiliate Partners in Care. For more information please visit or, or call (212) 609-7700.