At present, diabetes and its chronic complications have become serious diseases affecting human health, and severe complications are major causes of death and disability.Among chronic diabetic complications, neurogenic constipation can occur when autonomic neuropathy develops, and it is especially common in elderly diabetic patients.
Causes of Constipation
Diabetic patients often have misunderstandings about diet, such as eating too little and avoiding fruit entirely.Many elderly diabetics, despite having adequate financial means, rarely consume vegetables or fiber-rich foods and tend to have high-fat meals.In addition, due to excessive sweating, advanced age, and often accompanying diseases such as infarction, they fail to replenish water in a timely manner.Most elderly patients are rather stubborn, so health education often fails to achieve the expected effect.
Elderly people often suffer from multiple diseases, and some even have senile dementia with complete loss of self-care ability.Prolonged bed rest leads to weakened abdominal muscle contraction and reduced intestinal peristalsis.Some patients can partially take care of themselves, but their daily lives are mostly managed by family members or caregivers,resulting in many of them relying on laxatives for defecation.
Nursing Measures
Use medications for neuropathy
If economic conditions permit, patients may receive intravenous administration of nerve growth factor, prostaglandin E, B vitamins, etc.
Adopt a balanced diet
A proper ratio among various nutrients must be maintained to achieve a standard body weight.Food intake should match the patient’s standard weight and activity level.Patients should eat as instructed by their doctor.
Diabetic patients who wish to eat fruit must control the timing and amount.When blood glucose is well-controlled (2-hour postprandial blood glucose < 10.0 mmol/L),fruit may be included, but its calories must be counted into the total daily calorie intake,with a corresponding reduction in carbohydrates.
Fruit is best eaten between meals to avoid high blood glucose and prevent hypoglycemia.
Fruit selection:
Low-sugar fruits (can be eaten appropriately): watermelon, apple, pear, orange, kiwi, etc.
High-sugar fruits (should be minimized): banana, jujube, litchi, persimmon, hawthorn, etc.Since elderly people may have difficulty eating vegetables, they can be chopped and cooked soft.Vegetable porridge or vegetable noodles add flavor and supply fiber.
Fruits and vegetables are rich in dietary fiber:
Soluble fiber: pectin in fruits
Insoluble fiber: stems and leaves of vegetables, peels and cores of fruitsDietary fiber delays the absorption of blood glucose and blood lipids, maintains regular bowel movements, and reduces hunger.Diabetic patients should not restrict water intake; adequate drinking helps excrete metabolic wastes and dilute blood glucose.
Increase physical activity
For bedridden elderly patients: guide in-bed exercises, abdominal massage, and regular turning to promote gastrointestinal motility.For patients who can get out of bed: family members or caregivers should assist daily care and urge mild exercise2–3 times a day, such as walking indoors or around the ward.Help patients develop a habit of regular defecation.
Use laxatives and avoid enema as much as possible
Choose appropriate laxatives according to the doctor’s advice.For patients unresponsive to medication, manual evacuation may be used.
Enema should be avoided in elderly patients.In clinical practice, cleansing enemas in very old patients often lead to severe diarrhea, collapse, or even shock,so enema must be used with extreme caution.