Diabetes in the Elderly

Diabetes, Glucose Intolerance and the Over 65s

Diabetes is proving to be a new epidemic of this century, and with a hugely increasing senior population, current data suggests that about 20% of over 65s will develop diabetes at some point in their senior years.  A further 20% will develop some kind of glucose intolerance, meaning that around 40% of our senior population will suffer from health issues related to glucose intolerance.

This is not a factor matched worldwide, and in fact in some societies the percent of diabetes sufferers in old age can be as low as 3.5%.  Getting old does not necessarily signal an increased risk of diabetes, but changing lifestyles in western society over the last few decades are perhaps contributing to an increase in prevalence for glucose intolerance.

Although Diabetes is clearly a genetic disease, it is also clear that lifestyle factors influence a person with a genetic predisposition, and current diet and lifestyles in the United States are affecting an increase in the number of people being diagnosed with diabetes.

It is estimated that about half of our senior population suffer from some form of diabetes and do not even know it.  Part of the problem is that the symptoms of diabetes are masked by the normal physiological changes associated with aging.

The body’s renal threshold for glucose increases with the advance of age, and therefore 1glucosuria is not seen at the usual levels. A decreased thirst is also common with advanced age, so 2polydipsia is usually absent.  Dehydration can be more common as the elderly often have an altered perception of thirst and a delayed fluid absorption.  In addition, other symptoms that can signal diabetes are common symptoms of advanced age such as confusion and incontinence.  The change in carbohydrate metabolism that occurs in the elderly can affect the loss of first-phase insulin release, and some elderly patients can present autoimmune changes.

Diagnosis and Treatment of Glucose Intolerance in the Elderly

What can complicate the diagnosis and treatment of diabetes in the elderly is the physiology that affects the absorption of drugs.  A changing metabolism can radically affect the absorption and distribution of oral medications, and therefore establishing a stabilizing medication program can often be quite difficult.  This is furthermore complicated when an elderly person is taking a number of differing medications for a number of health conditions.  Medications can react with each other and reduce the effectiveness and required dosage.

Treatment for an elderly patient will more often than not be somewhat dependent on their cognitive ability.  The ability to recognize the onset of the autonomic signs of hypoglycemia and the ability to respond accordingly are important elements of the self-management of diabetes.

Diet and exercise are essential aspects of diabetes therapy.  Maintaining a dietary plan may be easier when an elderly person is in a care facility, than for those where care is managed within the home.

If you have concerns that you may have symptoms of glucose intolerance, or suspect an elderly relative may have some form of diabetes, accessing healthcare is vital to proper diagnosis and treatment.  In many cases a simple self-care program can alleviate symptoms.

Again, as mentioned earlier, the typical symptoms of diabetes are shared with other common signs of aging, and therefore the disease can go untreated.  The following symptoms and problems could indicate a glucose intolerance and a full physical assessment should be undertaken:

• lethargy and fatigue
• increased frequency of urination
• which can lead to incontinence
• dehydration
• disrupted sleep patterns
• deficiencies in essential minerals (as lost in excessive urination)
• poor wound healing
• blurred vision
• impotence
• impaired immune system
• confusion and hallucinations
• 3hyperglycemia

• Hemoglobin A1c – this test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated)
• Urine microalbumin to assess kidney health
• Dilated eye exam 
• Foot exam to assess for circulatory and nerve damage problems
• Assessment for the presence, or risk of, heart disease
• Consultation with a dietitian to plan for a diet plan
• Consultation to educate on blood glucose monitoring

Diabetes should not go untreated in the elderly, and it should not taint an elderly person’s ‘golden years’.  If diagnosed and controlled it can be often be managed quite easily.

Important Tips for Balanced Nutrition for Seniors with Diabetes

Unfortunately as age increases we can often find that our sense of taste and smell diminishes, and this can mean that food can lose some appeal.  Other medications can trigger digestive problems, and other advancing age complaints can hinder balanced nutrition.  Many elderly people living alone can struggle to prepare meals, and be it for social or financial reasons, a poor diet can be a side effect of advancing years.  Things like, arthritis, mobility problems, ill-fitting dentures, can all affect an elderly person’s interest in, and ability to, maintain balanced nutrition.

If you are helping to care for an elderly person, some important tips to helping maintain a good diet are:

• Ensure that fewer small meals are eaten each day
• Ensure carbohydrates are distributed evenly throughout the day to improve glycemia
• Opt for fruit instead of fruit juice, as this tends to exacerbate the tendency for hyperglycemia
• Ensure plenty of fresh fruit is eaten, or buy fruits in their own juices and not syrups
• Ensure adequate portions of protein are included throughout the day
• Use herbs and spices to flavor, instead of salt
• Ensure the intake of plenty of fluids
• Try and make extra portions, so these can be frozen
• Ensure an adequate level of fiber to stimulate the digestive system and combat constipation
• Try and include new foods and recipes
• Remember that presentation can be an important part of stimulating an appetite
• Where possible, try and make some meals social.  Isolation and depression can easily suppress an appetite
• Finally exercise is an important aspect of stimulating digestion, so try and ensure some daily basic activity

4Hypoglycemia, in difference to hyperglycemia, occurs when the blood sugar level drops below a specific level (this can be dependent on factors such as age & personal health).  It can occur in diabetics when they experience a sudden drop in blood sugar levels.  Symptoms typically include such things as:

• Palpitations, or increased heartbeat
• Headaches
• Excessive sweating
• Dizziness, light-headedness or fainting
• Sleepiness
• Blurred, or double, vision
• Excessive hunger

Visit www.diabetes.org for more information.

Notes:

Type 1 diabetes = insulin dependent
Type 2 diabetes = non-insulin dependent

1Glucosuria or Glycosuria is the excretion of glucose into the urine. Normally, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes.

2Polydipsia is a medical symptom in which the patient displays excessive thirst.  It is often one of the classic initial symptoms of diabetes.

3Hyperglycemia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood.  Chronic levels can cause organ damage.

4Hypoglycemia, or low blood sugar, is a condition in which the level of glucose circulating in the blood falls below a specific level.