Diabetes in old age

Diabetes can lead to dangerous health problems, such as having a heart attack or stroke.

The good news is that there are things you can do to take control of diabetes and prevent its problems.

People get diabetes when their blood glucose level, sometimes called blood sugar, is too high.

Our bodies change the food we eat into glucose. Insulin helps glucose get into our cells where it can be used to make energy. If you have diabetes, your body may not make enough insulin, may not use insulin in the right way, or both. That may cause too much glucose in the blood.

There are two kinds of diabetes that can happen at any age.

In type 1 diabetes, the body makes little or no insulin.

This type of diabetes develops most often in children and young adults.

In type 2 diabetes, the body makes insulin, but doesn't use it the right way.

It is the most common kind of diabetes.

You may have heard it called adult-onset diabetes. Your chance of getting type 2 diabetes is higher if you are overweight, inactive, or have a family history of diabetes.

It's important to keep type 2 diabetes under control. Over time it can cause problems like heart disease, stroke, kidney disease, blindness, nerve damage, and circulation problems that may lead to amputation.

People with type 2 diabetes have a greater risk for Alzheimer's disease.

Amongst the elderly population, type 2 diabetes is a growing problem, and a larger proportion of newly diagnosed diabetics are older. Treating and diagnosing diabetes amongst the elderly requires a flexible and unique approach.

Other disabilities associated with aging can contribute to the complexity of strictly self-managing diabetes.

Impaired physical functioning amongst some elderly patients can mean that adjusting to a diabetes care routine is more difficult. Cognitive impairment can also provide an obstacle.

Managing diabetes amongst the elderly may often have different objectives to treating the condition in younger patients. Some drugs may be less suitable for elderly patients, and treatment plans will almost certainly have to be adjusted.

Treating geriatrics with diabetes requires the caregiver to take a multidisciplinary role. The goals should always be the reduction of diabetes-related complications. Many older people with diabetes are under treated.

When a loved one has been diagnosed with diabetes, you naturally want to do everything you can to ensure their continued good health and quality of life. But where do you begin? What should you know? How do you start?

Specifically designed with the needs of the seniors with diabetes in mind, these guidelines take into consideration that older people with diabetes. Experience higher rates of premature death and mental and physical disability.

Are more prone to develop coexisting illnesses, including high blood pressure, heart disease and stroke

Have an increased risk for several common conditions associated with the aging process, such as depression, reduced mental function, urinary incontinence, harmful falls, persistent pain and overmedication.

Clinical studies have shown that aspirin use can reduce the risk of heart attack and other heart disease in older adults with diabetes.

Unless there are special circumstances where it could be harmful, 81 to 325 mg of aspirin per day is recommended for older adults to lower the risk of stroke and heart attack.

Older people with diabetes who have high LDL cholesterol should be given diet and exercise changes or put on cholesterol-lowering medication.

Several studies have shown that lowering LDL cholesterol reduces the risk of heart attack and stroke in older people with diabetes.

Older adults with normal or nearly normal LDL cholesterol and low HDL or elevated triglycerides should be offered medicine in addition to nutrition education.

Nutrition education, increased exercise, and weight loss also improve cardiovascular health in older adults with diabetes.

There is strong evidence from a number of clinical studies that drug therapy for blood pressure management reduces death from heart attack and stroke in middle-aged and older people.  Because older adults may have less tolerance for blood pressure reduction, it should be treated gradually to avoid complications. 

Studies show that education on medication use, blood glucose monitoring, and recognizing high and low blood sugar can greatly improve a person’s blood glucose control.

For many people, especially those with diabetes complications, one-on-one counseling or group classes with a diabetes educator can improve diabetes control.

Older people should have regular eye exams, foot exams, and tests of kidney functioning. Studies show that early diagnosis and treatment of diabetic retinopathy2 reduces the risk of blindness.

All people with diabetes should have a foot examination at least once a year.  Regular foot exams allow early diagnosis of diabetic and injuries which might turn into ulcers and lead to amputation.

Among people with diabetes, smokers have a higher risk than nonsmokers of premature death from heart disease.  The good news: in just 2 to 3 years after quitting smoking, the risk of coronary heart disease falls to levels similar to those of people who never smoke

Screen and treat for the following age-related conditions that are more common in older people with diabetes: depression, harmful falls, urinary incontinence, forgetfulness and other mental problems, and persistent pain.

Failing memory and other losses of mental ability make it harder for the older person to check their blood sugar, feed themselves properly and remember to take their meds on schedule

Older adults with diabetes can experience pain from nerve damage, and those with pain are often under-treated.

Older adults with diabetes are at high risk for drug side effects and drug interactions, because they may take several drugs each day to manage blood sugar, cholesterol, blood pressure, and other conditions.

The doctor should review every prescription and over-the-counter drug, ointment, and supplement being used by the patient at every visit and check that the person is taking each medicine properly. 

Here are some things to keep in mind:

Have yearly eye exams. Finding and treating eye problems early may keep your eyes healthy.

Check your kidneys yearly. Diabetes can affect your kidneys. A urine and blood test will show if your kidneys are okay.

Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you're over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.

Check your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems.

Care for your teeth and gums. Your teeth and gums need to be checked twice a year by a dentist to avoid serious problems.

Find out your average blood glucose level. At least twice a year, get a blood test called the A1C test. The result will show your average glucose level for the past 2 to 3 months.

Protect your skin. Keep your skin clean and use skin softeners for dryness. Take care of minor cuts and bruises to prevent infections.

Look at your feet. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can't. If you have sores, blisters, breaks in the skin, infections, or build-up of calluses, see a foot doctor, called a podiatrist.

Watch your blood pressure. Get your blood pressure checked often.