Aging Americans fight diabetes differently

Diabetes management can be complicated business for older adults, but health professionals say a simpler approach could be safer.

Diabetes management can be complicated business for older adults, but health professionals say a simpler approach could be safer.

America is growing older and wider. At the same time baby boomers (the population born between 1946 and 1964) are celebrating their 65thbirthdays, obesity rates in the United States are skyrocketing. Seventy-five percent of Americans are currently living beyond the age of 65, which is great news. But more than one-third of them (35.4 percent) are obese.

As the age and weight of the population increases, so does the prevalence of type 2 diabetes. Nearly 27 percent of older adults have diabetes, compared with about 14 percent of individuals between the ages of 45 and 64.

“As we age, the combination of people’s failing organ systems due to age, diets high in sugars and fats, and familial risk for diabetes all come to a point where patients start having the symptoms and signs of diabetes at an older age,” says Juan F. Castro, M.D., medical director of the diabetes education program at the Texas A&M Health Science Center Coastal Bend Health Education Center (CBHEC) in Corpus Christi, Texas.

For these patients, a diagnosis of diabetes often seems like a death sentence. But people over 60 who have diabetes can maintain quality of life for years to come. And luckily for them, treating type 2 diabetes in older adults tends to be less rigorous than it is for younger people.

Serious complications of type 2 diabetes typically develop over decades. So while younger diabetes patients work hard to prevent them, for older patients with fewer years left, aggressive treatment (using medications to keep glucose levels between 90 and 120 mg/dL) might cause more harm in the short term than it may prevent.

“As we age, our organs don’t function as well, so we become more susceptible not only to diabetes but to other chronic diseases,” said Castro. So for older adults who have several chronic conditions and medications to treat each of them, controlling blood sugar can be complicated business where there’s no room for error.

What’s more, aggressive treatment of diabetes in older adults can lead to hypoglycemia, or extremely low blood sugar. For older adults, this condition might be more dangerous than a high blood sugar reading.

“When someone becomes hypoglycemic, they get light headed, which can make them fall,” said Manuel Guajardo, registered nurse and certified diabetes educator with the Texas A&M CBHEC diabetes education program. “Falling can lead to serious injury for seniors, such as broken hips and ribs.”

For this reason, Guajardo says achieving a certain number might not be the best approach for older adults. In fact, some older diabetes patients might feel ill if their blood sugar reaches an “ideal” level.

“Most of these people have lived with elevated blood sugar for ten, twenty, thirty years before they’re diagnosed,” said Guajardo. “For them, that’s the norm. We don’t want to let their blood sugar go too high, but they might be perfectly fine maintaining levels that are a bit higher than the guideline.”

Age also brings other barriers that can add to the complexities of diabetes self-management. Declining vision makes it more difficult to read prescription bottles and glucometers; cognitive impairment affects decision making and retention of new information; physical decline makes it harder to shop and cook, not to mention being physical active.

But while these barriers may be greater for much older adults, some might be fully capable of doing all the above.

“Each patient is different,” Guajardo said. “We have to take into account their living situations – at home or in assisted living – their mobility, transportation, number of medications, psychosocial needs. All of these factors change the formula. There’s no single combination that works for everyone.”

And while physical activity is crucial, patients might fear falling or unsafe neighborhoods. But health educators recommend starting by walking for a few minutes a day inside, then moving to the sidewalk or nearby track. Water fitness is a good alternative for older patients who have joint problems.

To get the most out of diabetes treatment and to learn more, Castro recommends attending a diabetes self-management education (DSME) program and bringing at least one relative or close friend. A list of DSME providers is available through the American Diabetes Association.

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