Diabetes Care in Older Adults
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Diabetes Care in Older Adults

Diabetes Care

Diabetes has become a major health concern for adults in America, and it is disproportionally affecting older adults. The American Diabetes Association states that one in four people over 60 has Diabetes. That makes it crucial to educate yourself to help identify symptoms, causes, and potential treatments.

Increased chances for heart disease, peripheral vascular disease, and stroke are just three areas of concern among the seniors with Type I or Type II Diabetes. Seniors with the disease are at risk for a lower functional status that reduces their quality of life. The following information will help you live the best life possible through proper care and treatment.

What Is Diabetes?

Diabetes, also referred to as Diabetes Mellitus, is a group of diseases that generate high glucose levels in your blood. Glucose is a basic form of sugar that the body breaks food down into, providing energy to the cells. Humans produce a hormone called insulin that helps convert glucose into energy, and it is the lack of this hormone (or sporadic production of it) causing Diabetes Mellitus.

Types Of Diabetes

Diabetes Mellitus can break down into several categories:

  1. Type I Diabetes;
  2. Type II Diabetes;
  3. Gestational Diabetes;
  4. Prediabetes.

Type I

Those with Type I diabetes live in a body with a pancreas that produces no insulin or produces it in insufficient quantities. It can develop in the elderly, but diagnosis occurs at a much earlier age in most patients.

The cause of the disease is the destruction of beta cells in the pancreas. It may occur due to an autoimmune disorder, as an inherited trait, or through an environmental trigger (not from diet or lifestyle).

Symptoms include hunger/thirst, bedwetting/frequent urination, fatigue/weakness, blurred vision, mood swings, and weight loss.

Treatment for this type of diabetes requires insulin, injected before meals to help manage glucose levels. Creating a proper diet, blood monitoring, and exercise are also part of the management of Type I diabetes.

Type II

People with Type II diabetes represent about 90 to 95-percent of the diagnosed population. It is the type of diabetes that most seniors will develop in their lifetime. The disease causes cells to respond abnormally to insulin.

That lack of response is due to something called insulin resistance. Insulin resistance occurs from high glucose levels in the blood, causing more insulin to enter the bloodstream. Eventually, the cells become resistant to high levels of insulin.

The symptoms are similar to Type I, with headaches, tingling hands/feet, swollen gums, and slow healing wounds added to the list. Seniors can use weight loss, diet changes, blood monitoring, and exercise to manage the disease. If that does not work, medications or insulin therapy will help with treatment.

Gestational

Gestational diabetes develops in women who become pregnant, and their bodies can not produce enough insulin. Menopause usually signals the decline of fertility (five to ten years before in many cases), but a senior can become pregnant.

While diabetic symptoms mimic some pregnancy experiences, blurred vision, yeast infections, and weight loss (even with an increased appetite) are noticeable. An elderly woman who becomes pregnant will likely be working closely with a doctor, so monitoring and testing may uncover issues before they appear.

Treatments include insulin therapy, blood monitoring, diet changes, exercise, and observation of the baby. It is also worth noting that women who develop gestational diabetes during pregnancy have a 50-percent chance of developing Type II diabetes later in life.

Prediabetes

Roughly one in three Americans are prediabetic, meaning that their cells do not respond to insulin in the bloodstream in a normal way. The glucose levels are higher than they should be, but they are not high enough to diagnose Type II diabetes.

Symptoms include being older than 45, overweight, low activity levels, or inherited genes (or previous gestational diabetes from pregnancy).

Prediabetes is the one type of this disease that is reversible if treated. The treatment plan will include diet, exercise, and blood testing.

How Does Diabetes Affect the Body?

Pre-diabetics and seniors with diabetes can display symptoms and complications throughout their bodies. The following sections look at some of the organs and body systems you and your doctor can look at as you create a treatment plan.

The Pancreas

For diabetics or pre-diabetic, the problem starts with the pancreas. The organ is part of your digestive system, creating enzymes to convert foods and hormones to regulate energy levels.

The enzymes the pancreas produces are:

  1. Amylase – Breaks down starches into sugars;
  2. Lipase – Breaks down fats so the body can absorb it;
  3. Protease – Breaks down proteins for health and tissue development.

The hormones the pancreas generates include:

  1. Amylin/Gastrin – Exert invluence over stomach functions;
  2. Glucagon – Messages liver to release stored sugars;
  3. Insulin – Signals cells to absorb sugar in the blood or to store it in the liver.

The hormone insulin comes from the pancreas’ beta cells, which make up nearly 75-percent of the organ’s hormone-generating cells. Diabetes develops when these cells produce insufficient insulin or produce insulin that the body can not use.

As the body ages, organs like the pancreas can be affected. Diabetics (or those who develop Diabetes) can become more susceptible to pancreatic conditions that manifest at increased rates in the elderly. That includes gallstones, acute pancreatitis, and pancreatic cancer.

The Liver

With a list exceeding 500 vital functions, one could say that the liver is one of the busier and most crucial organs in the body. It is the largest internal organ, weighing three pounds in an average-sized adult. One of the liver’s functions is to act as a filter, removing and storing excess glucose in the form of glycogen.

The liver can use glucose to respond to external factors in the body, including:

  • Stress – Triggering the “fight or flight” response to hormone releases from the adrenal glands messages the kidneys to release glycogen into the blood;
  • Exertion – Physical activity uses glucose and triggers the organ to release stored glycogen into the blood to replace the energy used.

As the body ages, this organ’s volume decreases up to 40-percent. The loss in size results in a reduction of mass in the liver cells. Those 65 or older display a 35-percent lower blood volume in the organ versus those aged 40 years or less.

Seniors also begin to store excessive visceral and abdominal fats, contributing to insulin resistance. Data also indicates that the risk of developing Nonalcoholic Fatty Liver Disease (a build-up of excess fat in the liver) increases as you age. Insulin resistance can also cause an excess of fat storage in the liver.

Cardiovascular/Circulatory Systems

Excessive glucose levels in the blood can damage all parts of the cardiovascular system over time. It reduces the elasticity of the blood vessel’s walls, resulting in these narrowing. The restriction of the blood vessels increases blood pressure and can damage the circulatory system.

These diseases are called Macrovascular (large blood vessels) or Microvascular (small blood vessels) and can lead to issues with:

  • Macrovascular Disease – Heart attack, peripheral arterial disease, and stroke;
  • Microvascualr Disease – Eyes, kidneys, and nervous system.

In the United States, heart disease is the leading cause of death for Americans. Those with diabetes are twice as likely to develop heart disease (or stroke) at a younger age. Seniors often become more susceptible because of lower levels of activity and diet, creating a perfect storm for underlying circulatory issues.

Poor circulation also affects your body’s ability to fight infections and heal wounds. Cardiovascular problems reduce the amount of blood reaching the problem area, resulting in less oxygen and nutrients for damaged or infected cells. That can lead to infections spreading and wounds that will not close.

Nervous System

The nervous system acts as your body’s CPU, controlling automated responses, mental functions, and body movement. Seniors can attest to how age affects their nerves as they experience declines in coordination, reflexes, strength, and thinking. Elderly diabetic patients can experience damage from high glucose levels that accumulate over time.

Roughly 50-percent of those with diabetes experience damage to the nervous system in the form of Diabetic Neuropathy. It develops into one or more types of nerve damage:

  1. Autonomic Nerve Damage – Affects circulatory, digestive, reproductive, and sensory organs;
  2. Focal Nerve Damage – A single nerve in the hand, head, leg, or torso;
  3. Peripheral Nerve Damage – Located in the arms, feet, hands, or legs (Note that this is the most common type of diabetic neuropathy);
  4. Proximal Nerve Damage – Affects buttocks, hips, thighs, or torso.

Complications for damage to parts of the nervous system can reduce the quality of life for the elderly, and serious instances will create other health issues or early death.

Kidneys

Your kidneys act as a filter, removing extra water and wastes from the blood at a rate of 1/2-cup each minute. These liquids move down a pair of ureters into the bladder, where stored urine sits until exiting the body. Each of these organs helps to make the urinary tract.

The damage from microvascular disease limits the effectiveness of filtering done by the kidneys. Damaged kidneys cause the body to retain more slats and water, and diabetics will develop kidney disease more frequently, depending upon the type of diabetes they have:

  • Type I Diabetics – About 30-percent suffer kidney disease;
  • Type II Diabetics – Between 10 and 40-percent eventually develop the condition.

It is also worth noting here that autonomic nerve damage can affect bladder function. That can make it more difficult to empty the bladder or cause urine backups that damage the kidneys. Also, diabetic urine with high glucose levels can develop infections if left sitting in the bladder.

Kidney damage and the development of kidney disease take time, so it is a condition that is diagnosed more often in older patients.

Eyes

As people get older, their eyes often weaken. From losing the ability to see objects up close to several eye diseases, this sensory organ is sensitive to the changes related to aging. Diabetes can affect your eyes due to circulatory (microvascular disease) and nerve damage (diabetic neuropathy).

Age and high glucose levels in the blood increase your chances of suffering from:

  • Cataracts – A clouding of the lens that blocks vision;
  • Diabetic Retinopathy – Affecting vision over time due to blood vessel damage;
  • Glaucoma – Loss of vision due to building pressure in the eye;
  • Macular Edema – Leaking of fluids into the macula.

These eye diseases can become progressively worse as people age, and in the most severe cases, a person can lose their sight altogether.

Brain/Mental Health

Your brain will shrink as you get older, and several chemical and neurological processes change or slow down with age. In elders that have diabetes, these conditions are exasperated with circulatory and nerve damage caused by persistent high glucose levels in the bloodstream.

Cognitive changes in the elderly are most noticeable in memory, and data shows an increase in strokes and vascular dementia among those with diabetes.

Mental health is becoming more of a focus for people of all ages, including seniors. Older people often become more isolated and socialize less frequently. They also tend to experience mental issues due to illnesses like diabetes, such as:

  • Anxiety – Sudden bouts of panic or paranoia due to health problems or medications;
  • Depression – Changes in one’s mood an outlook based on overall health;
  • Fatigue – Becoming mentally tired or overwhelmed from diabetic complications or treatment;
  • Stress – Tensions created by the cost and potential outcomes of diabetes and its underlying causes.

Deteriorating mental conditions can lead to poor diabetes management and worsening symptoms.

Other Organ/System Functions

Other complications can arise due to diabetes, including:

  1. Digestive issues;
  2. Fertility/Sexual complications;
  3. Metabolism changes;
  4. Skin damage.

Digestion

Damage to blood vessels and nerves can occur with aging, diabetes, or both. An example is nerve damage that causes Gastroparesis, which complicates food movement from the stomach to the small intestine.

Fertility/Sexuality

Aging already impacts a person’s reproductive system, and diabetes can complicate things even more. That includes nerve damage that interferes with sexual stimuli or blood vessel problems that creates erectile dysfunction or vaginal dryness.

Metabolism

Metabolizing nutrients into energy is critical for bodily function, and several conditions can develop due to a combination of age and diabetes. Examples include Diabetic Ketoacidosis, Hyperosmolar Hyperglycemic State, and Metabolic Syndrome.

Skin

Aging skin can be potentially bothersome, but adding diabetes to the mix brings with it increased chances of developing a multitude of skin conditions. Bacterial infections, fungal infections, and itching due to dry skin or poor circulation are common in seniors with diabetes.

Specific Challenges in Older Adults

The main issue with diabetic management is usually exercise. Limited mobility and muscle atrophy are what complicates matters.

Food can be an issue also. Diabetics will find that sugary foods and meals high in carbohydrates will cause their glucose levels to spike. Diabetic care for seniors must include:

  • Doctor consultation – Identify problems and create treatment plans;
  • Losing weight – Weight loss reduces blood sugar levels;
  • Exercise – Increasing daily movement and introducing workouts on several days during the week lower glucose numbers;
  • Proper diet – Maintain portion size using the food pyramid balances intakes of carbs, fats, and proteins;
  • Medication – Drugs like Metformin and Insulin therapy can regulate blood sugars;
  • Medical Equipment – Canes, walkers, wheelchairs, blood monitoring devices, free weights, and exercise bands can improve or maintain a higher quality of life.

FAQs

Can diabetes give you UTIs?

Diabetes often comes along with underlying conditions that impact blood flow and nerve sensory, increasing the chance for things like Urinary Tract Infections.

Can you get diabetes in old age?

Yes. You can develop any of the Diabetes Mellitus types, with Prediabetes and Type II being the most common in old age.

Is diabetes treatable?

Yes. All forms of diabetes are treatable through diet, exercise, medication, and insulin therapy.

Does Medicaid cover diabetes care?

Yes. Seniors eligible for Medicaid can have doctor appointments, medications, and equipment covered by their insurance, often with minimal co-pays.

Can diabetes cause falls in the elderly?

Yes. Damage to blood vessels and nerves could reduce muscle coordination, balance, movement.

Does diabetes make you age faster?

While data is inclusive regarding aging, diabetes will increase the chances for other health problems as a person ages.

Is diabetes more common with age?

It can be, as seniors are at a higher risk of developing Type II diabetes, especially if they have been prediabetic.

Does diabetes contribute to dementia?

The blood vessel and nerve damage associated with diabetes may contribute to Alzheimer’s and Vascular Dementia. Studies are still ongoing.

Hypoglycemia vs. hyperglycemia vs. diabetes: What is the difference?

Hypoglycemia describes the state where glucose levels are lower than normal. Conversely, hyperglycemia is the condition where your glucose levels are higher. Diabetes is a disease affecting your body’s ability to control glucose in the blood. It creates spikes (hyperglycemia) or drops (hypoglycemia) in blood sugars.

Age Well With Diabetes

Adult men and women already have plenty to deal with as they age. Adding diabetes to the list of issues might seem overwhelming, but it does not have to be.

Proper diagnosis, management, and treatment can slow down the effects of underlying health conditions. Getting proper nutrition and exercise can improve a senior’s current state, increasing the quality of life and extending the time one experiences it!

Sources

1. Older Adults – American Diabetes Association 

2. Epidemiology of Diabetes and Diabetes Complications in the Elderly: An Emerging Public Health Burden – National Library of Medicine

3. Gestational Diabetes – Centers for Disease Control and Prevention

4. Diabetes Mellitus in the Middle-Aged and Elderly Population (>45 Years) and Its Association With Pancreatic Cancer: An Updated Review – National Library of Medicine

5. Aging and liver disease – National Library of Medicine

6. Diabetes and Your Heart – Centers for Disease Control and Prevention

7. Diabetic Nerve Problems – Medline Plus

8. Diabetes – A Major Risk Factor for Kidney Disease – National Kidney Foundation

9. Common Age-Related Eye Problems – Cleveland Clinic

10. Ageing and the brain – National Library of Medicine

11. Diabetes and Skin Complications – American Diabetes Association

12. Gestational Diabetes – Centers for Disease Control and Prevention

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