Elderly and diabetes

About 50% of people with diabetes are aged 65 years and above.

Living with diabetes maybe tough as every day brings new challenges. As one gets older this becomes tougher and specific age related complications require diligence and care to deal with. This is tough, but not impossible.

“My mother has Type 2 diabetes, but she won’t eat. My father gets up and snacks in the middle of the night. My mom complains of going in a hypo (low blood sugar phase) just to eat sweets that she craves”.   I often hear these and other gripes from my patients’ carers (mostly their children) all the time.

Elderly people with diabetes have higher risks of complications like heart attacks, kidney disease and blindness; they’re more likely than other seniors to end up in nursing homes.

But we need to hold back a little and tell ourselves that when it comes to the elderly, quality of life is much more important than (almost sacred) numbers on the glucometer and other laboratory reports.

Most medical guidelines state that as a person ages, we need to be a bit lenient with target blood sugar values. Treating diabetes too aggressively can make elderly more prone to hypoglycaemia, or low blood sugar. For frail older people with multiple conditions, this can be more dangerous than high blood glucose readings.

There are a number of psychosocial issues that need attending to in the elderly. Poor vision, diminishing hearing, loss of balance etc makes them less confident in managing their own health.

Poor oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all make eating difficult. Older people tend to drink less fluids , which can cause dehydration, particularly during bouts of illness. People at risk should have a nutritional assessment and individual advice from a diabetes educator or nutritionist to address areas of concern such as needing extra calories, meal supplements and replacements, weight reduction, low salt diet or manageable foods.
​
It may not always be appropriate to reduce the fat, salt and sugar for every older person with diabetes. Poor or irregular eating can often be a cause of hypos.

Few health tips:

• Drink at least 8-10 glasses of water.
• Be physically active. Does not mean you need to hit the gym or aerobics, just be active throughout the day. Water the plants, walk the dog, make your snack etc. Physical activity helps you maintain healthy weight, prevent or control illness, sleep better, reduce stress, avoid falls and generally look and feel better, too.
• Quit smoking. 
• Eat well. Combined with physical activity, eating nutritious food in the right amount can help keep you healthy. Many illnesses, such as heart disease, obesity, high blood pressure, type 2 diabetes, and osteoporosis, can be prevented or controlled with dietary changes and exercise. Calcium and vitamin D supplements can help women prevent osteoporosis. If your blood sugar is under control a little cheating is also allowed.
• If chewing gets difficult, try and get nutrition from liquid and semi solid diets like, porridge with milk, yoghurt, smoothies, soups, poached eggs etc.
• Maintain a healthy weight.
• Prevent falls. We become vulnerable to falls as we age. Prevent falls and injury by removing loose carpets or throw rugs. Keep paths clear of electrical cords and clutter, and use night-lights in hallways and bathrooms. Did you know that people who walk barefoot fall more frequently? Wear shoes with good support to reduce the risk of falling.
• Get regular dental, vision and hearing checkups. 
• Manage stress. Try exercise or relaxation techniques—perhaps meditation or yoga—as a means of coping. Make time for friends, socializing and fun activities. Successful coping can positively affect our health and how we feel.

For older people with diabetes and their caregivers, the implications are clear.

Be on the lookout for symptoms of hypoglycemia, make sure you report these to your physician and be actively engaged in making treatment decisions.

Treat hypoglycaemia as an emergency. Immediately give 3 hard sugar candies/ 3 tsp sugar or honey or jam/ 3 glucose biscuits/ 150 ml juice or non-diet soda.

​ Avoid treating hypos with chocolates and other sweets like pastries as they contain high amount of fat, and takes more than 30 minutes before they start releasing sugar in the bloodstream.
​
And remember, staying positive goes a long way.