People with diabetes are living longer and healthier lives than ever. The life expectancy for PWDs has dramatically increased through the years (yay!), but that doesn't mean that diabetes gets any easier. In fact, as the well-respected endocrinologist and person with diabetes (PWD) himself Dr. Irl Hirsch put it at a conference earlier this year: we're seeing more "geriatric PWDs" these days and that presents a new host of issues that endocrinologists and patients traditionally hadn't had to think about.
Ironically, growing older with diabetes is the best thing that can happen to you... (Think of the alternative!) But while it's a positive, there are some distinct and difficult changes that occur when you hit your Golden Years.
Here's a quick run-through of things you should be aware of, either for yourself when the time comes or for your own aging parents (and we're talking about more than just "being good" about taking meds regularly).
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Although diabetes itself doesn't necessarily change as you age, the aging process itself makes tight diabetes control riskier. Complications, such as peripheral neuropathy or orthostatic hypertension (a form of autonomic neuropathy that affects balance), and low blood sugars can also cause more falls, broken hips and other broken bones. Ouch! So tight control can be dangerous. Some older PWDs might need to lighten up on aggressive control if they are frailer, live alone, or are at-risk for falls and broken bones.
Patricia Bonsignore, a diabetes educator at Joslin Diabetes Center in Boston, explains that the older you get, the less likely you are to feel your lows, which is why regularly monitoring your blood sugars is still crucial.
"We tell people that if you are feeling funny, you should check your blood sugar," Bonsignore explains. "They might be confused, and just not feel well. You might have different symptoms. And you don't want to rely on feelings, especially when you're older."
(I think dLife has a good piece of advice: Test, don't guess!)
Although monitoring and taking medication is still crucial, a PWD's goals in preventing low blood sugars sometimes change as they get older. Bonsignore explained that growing up without medical devices, many older PWDs got by throughout their lives on an extremely tight regimen of eating and exercise. Even though that may not be necessary today, that's how a lot of these folks are accustomed to living.
Bonsignore emphasized that just like people of any age, older adults are not heterogeneous. While some PWDs in their 80s might be living in a nursing home, others may be traveling around Europe! Diabetes management recommendations for elderly folks also have to be individualized.
Therefore, loosening management is not for everyone. Older PWDs who are very physically active and have a long life expectancy can maintain their same goals as younger PWDs, because for them, the benefits outweigh the risks.
Dr. Sei J. Lee, a geriatrician at San Francisco's V.A. Medical Center, told The New York Times: "If your parent is 70 and playing tennis three times a week, he or she should be treated like a younger patient."
How Physical Changes Affect Diabetes
For an elderly PWD who has managed their diabetes for a certain way for decades and memorized the steps, it can be difficult to transition to a new routine — even if the changes are aimed at making management easier, like switching from a vial and syringe to an insulin pen. This doesn't mean they can't or won't use an insulin pen or even a pump; there just might be more of a learning curve in adopting new technology.
Changes in cognition can also affect a person's ability to manage and problem-solve their diabetes. Bonsignore, the CDE from Joslin, explains, "If you see a lot of fluctuations, they might be skipping their dose or taking it twice. They can have other things that are affecting them, like loss of a spouse. They might have been the one helping with their diabetes, so if the spouse becomes ill or dies, they lose that support."
Plus, if you do have any diabetes complications, you don't want to accelerate any problems by giving up on managing your BG levels, and older PWDs still need to keep up on their doctor's appointments. As this diabetes1.org article points out: prevention is still powerful at any age.
The issue with older adults is that "things can change rapidly" in terms of their physical condition, Bonsignore explains. "Another thing we see is the need for family and caregivers to get involved. Things they were able to do on their own are things they might need help with now."
I've become friends with several older PWDs via the DOC, so I queried them on their experiences with diabetes in their "later years." Bob Williams, a 66-year-old patent agent in Minnesota who was diagnosed with type 1 diabetes as an adult, says he's still diligent about going in for regular doctor check-ups even after 20 years with diabetes. He says, "It always helps to have someone else look at how you're doing now and then. Kinda like you won't speed if you know there is a cop down the road."
Be Active, Stay Active
Ever heard the phrase "Use it or lose it"? That's pretty much how it works when it comes to staying fit and active. Regular exercise is good for everybody, but even more so for older folks. Cardio exercise and strength training helps keep blood sugars and weight down, but it also helps lower blood pressure and cholesterol, and it keeps bones strong. Women with type 1 diabetes are at an increased risk for osteoporosis, and women with type 2 are at an increased risk for bone fractures.
And don't think just because you're older it gives you an excuse to slack off.
Richard Vaughn, 72, a former teacher who wrote a book called "Beating the Odds" about his experiences living with diabetes for more than 64 years, says that his change in lifestyle with retirement has made diabetes easier to manage. He says, "I now have the opportunity to arrange my daily schedule any way I want. I could not do that while working because every day was different while teaching. The lack of consistency affected my blood sugar, giving me many highs and lows."
Another longtime PWD (and Facebook buddy of mine), 79-year old Tom Beatson who's been living with type 1 for 69 years, knows the importance of exercising to manage his diabetes. Tom joined an Arizona cycling club in 1978 and he's still going strong! He and his fellow cyclists bike 10-15 miles three times a week. Tom, a retired engineer, has kept meticulous track of his mileage, clocking in more than 106,000 miles over the years!
"I know I need to be exercising," Tom says. "And this has turned out to be the best way for me."
Seriously, you're never too old for exercise — or social networking, apparently!
The Great Unknown
Of course, there is a lot that we don't know about aging with diabetes because -- quite frankly -- not very many people have done it.
Insulin has been available for less than a hundred years, and those who are in their 60s, 70s, and 80s did not have access to much of the new medical technology that we youngins now have access to. The Joslin Diabetes Center, which awards medals to those who have lived with diabetes for 25, 50 and 75 years, studied folks who have lived with diabetes for 50 years to see how diabetes affects them. The study showed that out of 550 medalists, only 40% had diabetic retinopathy, and 10% had kidney problems.
70-year-old Betty Jackson of Philadelphia has lived with type 1 diabetes for 53 years (and she has the good fortune of being a fellow client of CDE favorite Gary Scheiner). Betty has this advice for growing old with diabetes: "Since being diagnosed I have always faced whatever health problems and tend to treat them as just another bump in the road of life. Oh, and laughter is the best medicine. Always look for the humor in any situation learn to laugh and keep those around you laughing!"
How diabetes is managed today compared to 1962 will obviously impact how healthy we are in the future. It's clear that it is possible to live a long, healthy and productive life with diabetes. Now try to get your head around the fact that growing old with diabetes is nothing to be afraid of.