Long Term Treatment Guide

Diabetes becomes more common as we age. Aging does not just affect the color of our hair and the tautness of our skin, it also affects all our internal organs. Our metabolism slows, our aerobic capacity diminishes, and our bodies become less adept at absorbing glucose from the bloodstream. We may become glucose intolerant, which may leads to type 2 diabetes.

Older adults who already have diabetes are at risk for developing the same complications as young people with diabetes. However, their risk factor for cardiovascular disease is much higher. They also suffer more dementia, depression, urinary incontinence, falls, and chronic pain. Diabetes complications can speed the aging process. Eye disease can worsen already-fading eyesight, diabetic retinopathy can complicate arthritis, and diabetic kidney disease can speed the decline of kidney function.

One major danger for elderly people with diabetes is that the incidence of hypoglycemia, low blood sugar, increases with age. Many elderly people take a lot of different drugs, which may interact with diabetes drugs to cause hypoglycemia. There’s a higher risk of “impaired glucose counter-regulation,” where the body fails to protect against low blood glucose like it does in younger diabetics. To compound this problem, elderly people may not be as aware of the symptoms of low blood sugar, such as sweating, dizziness, and hunger, or the hypoglycemia may cause confusion, so they fail to take preventive measures. Some elderly people also have poor appetites and miss meals, another trigger for low blood sugar.

For these reasons, the American Diabetes Association stresses individualized glucose targets for older people. Some doctors just try to get blood sugars down without adjusting for age, which could put a frail elderly diabetic at risk. “If you’re 80 and healthy, you can walk without difficulty and don’t have complications, I’ll keep your sugars as close to normal as possible, but if you’re 80 and frail, you don’t need such tight regulation. I’ll try to get your sugars down to 140,” says California endocrinologist Dr. Anne Peters, professor at Keck School of Medicine, University of Southern California and director of the USC Clinical Diabetes Program. “For healthy people, less than 7 on the A1C is the goal. For an older person with heart disease, 7.5 is safe. You should work with your physician to adjust your goal.”

Dr. Peters also notes that people who are older metabolize drugs more slowly, because their kidney function diminishes, so they need to be started on lower doses. However, medication costs can be a bigger issue for the elderly. For instance, Januvia is a great diabetes medication. It’s taken once a day and there no side effects. But a lot of patients don’t have coverage. The newer drugs may be better, but because they’re more expensive the doctor needs to come up with a balance.

Despite the difficulties of managing diabetes in older people, due to the advances in treatment, type 2 diabetics today are more likely than ever to live to a ripe old age without major complications if they take countermeasures to stay healthy.

Exercise is one of the most important strategies to slow the effects of diabetes over time. The downward spiral of aging, both for diabetics and non-diabetics, is a result of inactivity. Muscles that aren’t used sufficiently become weak, falls are more common, and the activities of everyday life become more and more difficult. Here are some recommendations:

  • Start walking. Aerobic exercise lowers blood pressure and blood sugar levels. Over time it lowers the risk of cardiovascular disease.  If walking is difficult, use an exercise bike, swim, or just move your limbs while sitting to get your heart rate up.
  • Do strength training. Building muscle mass improves glucose metabolism and blood sugar control.
  • Try yoga or Tai chi. Both of these enhance flexibility and balance, relieve stress, and enhance mood.
  • Eat right. This means eating regularly and focusing on low-fat, high-fiber, plant-based foods. Do not skip meals.
  • Get enough sleep. Studies have shown that sleep deprivation can lead to insulin resistance.
  • Go to the doctor regularly. Diabetics need regular checkups. Minor complications can easily turn into major ones without proper attention.
  • Socialize. Social connections have proven to be an important predictor of longevity. A network of friends means that others are concerned with your welfare and will encourage you to take care of yourself.