Diabetes and The Elderly
Living with diabetes can be tough at times. Diabetes cannot be completely cured, but it can be managed. Every day can bring new obstacles with unique challenges. As you age, these obstacles can become a bit more challenging, but not impossible. With age comes an increased risk for specific complications that require diligence and care to properly control them. To understand the challenges this disease brings to the elderly, we must first understand a little bit about the disease itself.
Diabetes is a disease that involves problems with the hormone insulin. When you eat or drink, your body changes the food you eat into sugar or known as glucose. Normally, the pancreas (an organ behind the stomach) releases insulin to help your body store and use the sugar from the food you eat. The glucose that gets used is transported through the bloodstream to the many cells in the body where it can be used to make energy that the body needs for daily activities. The amount of glucose in the body is tightly regulated by the hormone insulin as the pancreas increases and decreases the amount of insulin produced depending on the amount of glucose in the body. The more insulin produced will cause the glucose level to drop. If the glucose level gets too low, then your body releases some of the stored glucose kept in the liver. If your blood glucose or blood sugar level becomes too high in the blood and is not being transported and stored adequately, then the diagnosis of diabetes is made. Diabetes occurs when one of the following occurs:
When the pancreas does not produce any insulin
When the pancreas produces very little insulin
When the body does not respond appropriately to insulin, a condition called "insulin resistance"
There are two types of diabetes: Type 1 and Type 2. Type 1 diabetes occurs because the insulin-producing cells of the pancreas are destroyed by the immune system. People with type 1 diabetes produce no insulin and must use insulin injections to control their blood sugar. This type usually starts in people under the age of 20, but can occur at any age. Type 2 diabetes is slightly different because with this type the pancreas is still producing insulin. However, the insulin the pancreas secretes is either not enough or the body is resistant to it. When there isn't enough insulin or the insulin is not used as it should be, glucose can't get into the body's cells to provide energy and it remains in the blood thus raising the blood glucose level. This is the most common form of diabetes and the only one that can be prevented. It usually occurs in individuals over the age of 40 and most often in those who are overweight, inactive, or have a family history of diabetes.
Diabetes can lead to dangerous health complications such as blindness, nerve damage, circulation problems leading to amputation, heart attack, stroke, and kidney failure. Some people are able to manage Type 2 diabetes so well that they are able to go without injections or medications. Controlling weight, diet, and exercising regularly may be enough for some people. For others, it’s important to do those things plus medication. Even with the strictest of plans, there may be times when your blood sugar may become high. It is important to know and understand the symptoms of diabetes so you can catch it quickly to help yourself or your loved one. The symptoms of type 1 diabetes often occur suddenly and can be severe. They include:
Increased hunger (especially after eating)
Unexplained weight loss (even though you are eating and feel hungry)
Fatigue (weak, tired feeling)
Labored, heavy breathing (Kussmaul respirations)
Cognitive impairment (delirium, confusion)
Loss of consciousness
It is important to be vigilant in recognizing signs and symptoms of this disease because many of them seem as they go along with the aging process. The symptoms of type 2 diabetes include some of the above, but are usually on a more gradual development. Other symptoms may include:
Slow-healing sores or cuts often around the leg and feet area which usually because the cause of a needed amputation
Itching of the skin (usually in the vaginal or groin area)
Recent weight gain
Numbness or tingling of the hands and feet
At Mitchell-Hollingsworth, our nurses understand the goals of managing diabetes in the elderly and that treatment is very individualized. They have to take into account many different variables depending upon each resident’s current overall health and coexisting medical conditions. Some of our diabetics are very brittle diabetics while others are not. Hypoglycemia can be just as dangerous and sometimes even more so especially in a frail elder who may have increased falls, lower blood pressure, increased possibility of multiple drug interactions due to multiple medications, dehydration, or already impaired vision and cognition. The most important things our nurses look at in managing this disease are:
blood sugar levels- keep levels as near to normal as possible by balancing food intake with medication and activity
cholesterol levels- keep levels as near their normal ranges as possible by avoiding added sugars and processed starches, by reducing saturated fat and cholesterol, and taking a cholesterol medication such as a statin if needed
blood pressure- keep blood pressure in the normal ranges and preferably never over 130/80
In doing these, we are working to slow or possibly prevent the development of type 2 diabetes along with diabetes-related health problems. We encourage following a balanced meal plan, taking the correct amount of medication at the correct time, involvement in activity if able to do so, and allowing our on-site medical director to monitor labs and medications. The A1C blood test is often a good indicator of a well-designed treatment plan as it shows the glucose level for the past 2-3 months, but can sometimes be inaccurate in the elderly as other conditions such as anemia or recent blood transfusions may impact the red blood cells. Eye exams, urine tests, teeth and gum assessment, and skin assessments are all monitored on a regular basis to catch and avoid serious health problems. While we have all of our equipment on hand, an elder in the home might need to make sure they have at least 3 days’ worth of supplies with them at all times for testing and treating in case of an emergency. The overall goals of diabetes management in the elderly are similar to those in younger adults and include management of both hyperglycemia and risk factors with each person’s treatment plan individualized based on the person’s overall health and risk for hypoglycemia. Treatment regimens are chosen to achieve maximal glycemic control possible, with a focus on avoidance of hypoglycemia and control of hyperglycemic symptoms. For more information on diabetes, visit www.diabetes.org.