Diabetes In Elderly

How to Properly Manage Diabetes in Elderly Adults

by Dr. Lina Velikova, MD

As the US population continues to live longer, we’re seeing an increasing number of newly diagnosed diabetic senior patients. More than 25% of Americans aged 65 years and above have diabetes, which accounts for over 12 million seniors (diagnosed and undiagnosed). Although the awareness of diabetes is often linked to its impact on working-age adults, diabetes in elderly people is associated with increased mortality and reduced quality of life, as well as a greater risk of early isolation and institutionalization.

The problem with the diabetes epidemic is that patients with diabetes also often have one or more additional diseases. This can complicate patient management, and the risk of hospitalization and death substantially increases. You can read more about other conditions affecting seniors in our blog at medalerthelp.org.

Managing diabetes in the elderly population is particularly difficult. First, the condition is complex, requiring the involvement of multiple medical specialists. Second, the generally lower functional status of elderly patients can hamper the management of diabetes. Third, published guidelines often do not apply to geriatric care.

Thus, physicians have to individualize therapeutic approaches to elderly patients, which can cause high variations in patient outcomes. However, understanding the specifics of geriatric diabetes patients will help in finding the best treatment and follow-up care.

What Is Diabetes?

Diabetes mellitus, or just diabetes, is a severe chronic disease. The main feature of diabetes is high blood glucose, commonly called high blood sugar. The level of glucose in the blood depends on the function of a hormone called insulin. Insulin is produced by the pancreas. If cells can’t produce or respond to insulin, too much glucose can accumulate in the blood.

How Many Types of Diabetes Are There?

There are two main types of diabetes: type 1 and type 2 diabetes. While type 1 diabetes is characterized by low or no insulin production, type 2 is associated with reduced utilization of blood glucose in the tissues. Moreover, type 1 diabetes occurs most often in children and young adults, while type 2 occurs most often in middle-aged and older adults. Thus, seniors (those over 65) are more prone to develop type 2 diabetes.

A condition called “prediabetes” is used for people whose blood glucose levels are higher than the reference levels but still not high enough to be classified as diabetes. Prediabetes, however, is an underestimated problem because people who have it are at high risk for developing insulin-independent diabetes (type 2).

Prediabetes and diabetes in seniors are associated with an unhealthy lifestyle. The chance of getting these conditions rises if the person is overweight, inactive, or has a family history of diabetes. Since the risk of diabetes steadily increases with age, seniors are more vulnerable to developing the disease.

What Are the Risk Factors for Developing Diabetes?

People are more prone to develop type 2 diabetes if they:

  • Are over 45 years old and have one of the following – hypertension, obesity or family members with diabetes
  • Are over 55 years of age
  • Have heart disease or have had a heart attack
  • Have or have had prediabetes
  • Have or have had gestational diabetes
  • Have polycystic ovary syndrome and obesity
Diabetes In Elderly

Can Diabetes in the Elderly Be Prevented?

Fortunately, there are ways to lower the risk of developing diabetes. Although there are certain factors that cannot be changed, such as genes, age, or past behaviors. Healthy eating, losing unnecessary weight, and being physically active are game changers. Doctors are essential for setting up plans for proper nutrition and regular exercise, as well as providing help for quitting smoking. However, most importantly, it is necessary to regularly check blood glucose levels.

What Are the Signs and Symptoms of Diabetes?

A fundamental problem for older adults with diabetes is that the symptoms of diabetes in elderly patients may not be pronounced. Complaints such as feeling tired, hungry, or thirsty, may be attributed to the normal aging process. Thus, older adults may not suspect they have diabetes.

Furthermore, the picture is completed by symptoms like unintentional weight loss, frequent urination, or blurred vision. Sometimes skin infections or slow-to-heal cuts and bruises are the main symptoms. Here, the role of the senior’s family or their family doctor to recognize any diabetes signs is crucial. However, older people may remain undiagnosed until irreversible organ damage has been done.

Diabetes In Elderly

Which Tests Are Used for Diagnosing Diabetes?

There are several blood tests for diagnosing diabetes. A random plasma glucose test, which is given at any time during the day, and a fasting plasma glucose test, where the blood is taken after at least eight hours without food, are routine laboratory tests. However, all individuals above 65 should be screened annually for diabetes.

If the doctor suspects diabetes, he will suggest an oral glucose tolerance test. It’s comprised of two blood withdraws: the first taken after fasting overnight, and the second, two hours after having a sugary drink. The A1C (glycosylated hemoglobin) test can be performed at any time during the day. Furthermore, it may determine the blood’s average glucose level for the past three months.

Normal blood sugar levels for elderly adults range from 100 mg/dL to as low as 60–70 mg/dL depending on a laboratory’s reference range. According to the 2018 Clinical Practice Guidelines of the American Diabetes Association (ADA), prediabetes is established when fasting blood glucose varies between 100–125 mg/dL, whereas diabetes is diagnosed when fasting readings surpass 125 mg/dL. These numbers are the same for all adults, including seniors.

How Important Is It to Manage Diabetes?

Fortunately, a diabetes diagnosis is not the end of the world. Taking control of blood glucose can prevent further problems. A diabetic senior can be referred by the family doctor to a specialist called an endocrinologist. Once the patient has been diagnosed with diabetes, the doctor will choose the best treatment based on the type of diabetes, everyday routine, and additional health problems of the patient.

Managing type 2 diabetes in the elderly can be very successful. Sometimes even a change in diet and exercise alone can control blood glucose levels within the reference ranges. Other patients, however, need medicines or insulin injections. The most critical strategies are healthy lifestyle changes and proper medication.

Diabetes In Elderly Adults

How to Keep Diabetes Under Control

There are certain strategies used to control diabetes and avoid complications in order to reduce its negative impact on quality of life. Tracking glucose levels is mandatory. Managing diabetes in the elderly does not differ significantly from managing it in younger people except for special precautions due to any other diseases.

Here are the main precautions you need to take to keep diabetes under control:

Regularly Check Blood Glucose Levels

Running blood tests regularly at the lab or at home is essential for monitoring and controlling diabetes. Both very high (called hyperglycemia) or very low blood glucose levels (called hypoglycemia) can pose risks to the patient’s health.

Testing the percentage of A1C in the blood should be done at least twice a year. Even if the patients don’t control their diabetes well but managed to put their blood glucose level within the reference ranges for routine testing, the A1C test will show it.

A normal A1C for elderly people is between 5% and 5.6%, and it demonstrates the patient has had good glycemic control for the past three months. These values are associated with the smallest risk of all-cause mortality in patients with diabetes.

Make Healthy Food Choices

Seniors have to be encouraged to eat healthier by choosing good carbohydrate-containing foods such as fruit, vegetables, and whole-grain bread. They have to learn how different foods affect glucose levels, know how to watch their diet, and make healthy choices. Being educated on a suitable diabetes diet has proven its significance for diabetes patients, especially older ones.

Make Lifestyle Changes

Aside from diet compliance, patients should also monitor their weight and lose some excess pounds if they need to. For weight loss, consulting a nutritionist could benefit patients. Patients have to meet the challenge of balancing between losing weight and keeping the blood glucose levels within the normal ranges while using low-fat and low-sugar products. Choosing the right foods to fulfill their needed vitamin levels, despite the diet, is essential.

Diabetes in seniors could also be controlled by daily exercising. Physical activity, within their abilities and under the guidance of a doctor, sustains glucose levels by improving their muscle utilization. Since muscle tissue is reduced in older people, doing some form of exercise helps with diabetes. Nevertheless, quitting smoking, especially in diabetes patients, significantly reduces the risk of many health problems, including heart attack and stroke.

Adopting a healthier lifestyle that includes a healthy diet, physical exercise, losing weight, and quitting smoking will only contribute to a patient’s well-being. In some cases, lifestyle changes may eliminate the need for diabetes medication.

Take Your Diabetes Treatment Seriously

Some patients need treatment with medications to maintain proper glucose levels in the blood. Some seniors receive oral diabetes tablets, whereas others need insulin. However, it’s essential to take diabetes medicines according to a doctor’s instructions—even when the patient feels good. It is important to share any concerns regarding prescribed drugs, including any side effects or difficulties in affording them.

Keep Your Cardiovascular System in Good Shape

Measuring blood pressure regularly and providing treatment for high blood pressure, if present, is a must in geriatric diabetes patients. Cholesterol and triglycerides, which are fats found in the bloodstream, should be checked regularly, at least once a year. It is important for the patient to know that high levels increase the risk of heart problems. Thus, the physician will ensure treatment with medications if fats levels in the blood are outside the normal range.

Get Routine Checkups to Discover Early Complications

Among the most sensitive organs to long-term hyperglycemia are the eyes and kidneys. Finding and treating eye problems, such as diabetic retinopathy, by attending yearly eye exams can keep your eyes healthy. Diabetes in elderly people also attacks the kidneys, causing diabetic nephropathy. Therefore, routine urine and blood tests are recommended to track any kidney problems.

Be Wary of Diabetic Foot Problems

Diabetes patients’ feet should be checked every day for any signs of ulcers or infections.  If the patients can’t do it by themselves, they should ask someone else to check their feet. If there are sores, blisters, breaks in the skin, infections, or a build-up of calluses, the patient should see a podiatrist. Wearing proper shoes is another great preventative measure.

Maintain Proper Skin and Oral Hygiene

Minor cuts that are difficult to heal could be one of the first signs of geriatric diabetes. Any wounds or bruises have to be managed accordingly to prevent infections. Keeping skin clean and using skin softeners for dryness are the best ways to protect it. Senior patients also have to pay attention to the care of their teeth and gums. Brushing teeth and flossing keeps the problems away.

Protect Your Immune System

High glucose in the blood inhibits the circulating immune cells. Thus, people who have diabetes are more prone to infections than people with normal blood glucose levels. Regarding diabetes in the elderly, guidelines recommend up-to-date vaccinations against pneumonia for people over 65 and a yearly flu shot. However, people who were younger than 65 when they had the pneumococcal vaccine may need another one after the age of 65.

Be Prepared

It’s so easy to forget, but patients with diabetes should always have at least three days’ worth of supplies on hand for testing their blood glucose and treating diabetes in case of an emergency.

What Are the Main Complications of Diabetes?

Since diabetes can affect many organs, it is essential to keep blood glucose levels under control to minimize the impact of diabetes in the future. With diabetes in the elderly, complications are often related to high blood pressure or high levels of certain fats in the blood that can speed up the progression of other common complications caused by diabetes.

Severe health problems like heart disease, stroke, kidney disease, vision loss, nerve damage, and circulation problems that may lead to amputation or erectile dysfunction (impotence) in men could be considered complications of diabetes. Additionally, patients with type 2 diabetes also have a higher risk of Alzheimer’s disease.

Diabetes In Elderly Adults

FAQs

What are the early signs of diabetes?

Common warning symptoms for both types of diabetes are hunger and fatigue, peeing more often and being thirstier, dry mouth, itchy skin, and blurred vision. For type 2 diabetes, additional symptoms include yeast infections, slow-healing sores or cuts, and pain or numbness in your feet or legs.

What is the most common type of diabetes found in the elderly?

The most common type of diabetes found in seniors is type 2—previously called insulin-independent diabetes. Type 1 diabetes is inherited and usually diagnosed much earlier, typically in infancy.

What is the normal blood sugar level for the elderly?

According to the 2018 Clinical practice guidelines of the American Diabetes Association’s (ADA) normal blood sugar levels for the elderly are defined as less than 100 mg/dL. Fasting readings above 100–125 mg/dL are classified as prediabetes, whereas fasting blood glucose above 125 establish the diagnosis of diabetes.

How do you feel when your blood sugar is too high?

Some of the most common symptoms associated with hyperglycemia are the following: thirst, tiredness, blurry vision, frequent urination, as well as unintentional weight loss. Very high blood sugar can cause you to faint, feel nauseated, and even throw up. It can also cause dehydration, especially in older people.

Can high blood sugar cause confusion in the elderly?

Confusion is related more to hypoglycemia than to hyperglycemia. A low blood glucose level also leads to other very unpleasant symptoms like speech and self-care difficulties, aggressive behavior, unsteadiness and falls, losing consciousness, and cognitive damage, as well as heart attack or stroke.

Can you get rid of diabetes?

Diabetes, like hypertension, is a lifelong disease. Thus, it cannot be “cured.” However, by controlling the blood glucose within the reference ranges, the patient will feel relatively healthy.

What happens if you leave diabetes untreated?

If diabetes remains untreated, this puts the patients at significant risk of a range of serious health problems. Fortunately, these risks can be vastly reduced by appropriate medical treatment and lifestyle changes.

Can diabetes kill you?

Diabetes itself cannot kill its patients. However, long-term high concentrations of blood glucose can lead to enormous damage to nearly every major organ in the body, including kidney damage and failure; artery damage, which increases the risk of stroke and heart attack; nerve damage, which can lead to traumatic injury; and infection, possibly leading to limb amputation. Thus, the mortality rate of patients with diabetes is increased due to diabetic complications.

Can you claim any benefits for being diabetic?

Diabetes is listed in the so-called “Blue Book,” which is the impairment listing manual of the Social Security Administration. Diabetes, regardless of the type, is a condition that can qualify a person for Social Security Disability benefits. To be eligible for any gains on the basis of diabetes diagnosis, the patient should be diagnosed as having diabetes mellitus (type 1 or type 2) and at least one of the following conditions: neuropathy, acidosis, or diabetic retinopathy. After approval, the patient will receive a vocational medical allowance not to return to their previous work or perform any new but unsuitable types of work.

Conclusion

Diabetes in elderly people is a challenge; patients must stay in regular contact with their doctor and inform any health professionals with whom they come into contact that they have diabetes. Working together with their doctors and any other healthcare professionals and diabetes educators could teach diabetes patients how to keep their diabetes under control and avoid complications.

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