Last Updated: March 29, 2014
By Jeannette Franks, PhD
My career working with older people began 25 years ago at Community
Services for the Blind where friends, staff, volunteers, and
clients had lost their sight due to complications from diabetes.
Some died at an early age. Today we know much more about the
prevention, diagnosis, and treatment of type 2 diabetes and related
vision loss than we did then. Nevertheless, more Americans than
ever are afflicted with this disease. It has the fastest-growing
death rate in the US and increasingly attacks people of a younger
age. According to a recent New York Times article, type 2 diabetes
is now epidemic in proportion.
Type 1 diabetes affects 5% of all people with diabetes and
occurs mostly in people under the age of 20. In this condition, the
pancreas produces insufficient insulin to maintain normal glucose
(blood sugar) levels.
The vast majority of people with diabetes have type 2 diabetes,
which is characterized by hyperglycemia (excess blood sugar) and
insulin resistance. It can cause not only vision loss, but kidney
failure, nerve damage, cardiovascular (heart and other artery
blockage) disease, as well as increased infections and slowed
healing, sometimes resulting in amputation. Type 2 diabetes in
seniors is particularly problematic.
Signs and symptoms
The most common initial symptoms of type 2 diabetes are
increased thirst and frequent urination. Excess glucose in your
bloodstream sucks water from tissues, forcing you to want to take
in more liquid and consequently excrete more fluid.
Before an obvious symptom appears, type 2 diabetes is frequently
asymptomatic for many years because it develops slowly. Often it
seems like something else is going on. For example:
- Flu-like symptoms. Feeling lethargic, tired,
or chronically weak can be a sign of type 2 diabetes. Sugar is fuel
for your body and when it doesn't get used properly, your body runs
out of energy much like a car running out of gas.
- Weight loss or weight gain.Because your body
is trying to make up for lost fluid and fuel, you may eat more. The
opposite can also happen. Even though you eat more than usual, you
lose weight because your muscles don't get enough glucose.
- Blurred vision.Excess levels of sugar pull
fluid from the lenses of your eyes, affecting your ability to
focus. If your vision ever changes noticeably over a brief period
of time, see a physician immediately.
- Sores that heal slowly or frequent
infections.Urinary tract infections are especially a
problem for older people.
- Numbness and tingling in arms and
legs.Decreased circulation can cause neuropathy (nerve
damage). You may experience a lack of feeling in, or conversely,
burning pain in your legs, feet, arms, and/or hands.
- Gum disease. Watch for increased senior
dental problems and infections in your mouth. Type 2 diabetes
can cause your gums to be red and inflamed, putting your teeth at
In order to understand what causes diabetes, it's helpful to
first understand a little about how your body normally uses
insulin. After you eat, your body breaks down carbohydrates from
bread, rice, pasta, vegetables, fruits, and other foods into sugar
molecules, especially glucose. However, glucose cannot enter your
cells without the help of insulin, which the pancreas produces
continuously in a healthy individual. As the blood sugar increases
after a meal, insulin production also increases. The insulin
unlocks cells so that glucose can enter them. When a person has
diabetes either the pancreas doesn't produce enough insulin, or
cells begin to resist the insulin. When that happens, sugar can
build up in the blood and begin to cause the symptoms described
- Being overweight is possibly the number one
risk factor. Increased weight increases the fatty tissue, and
increased fatty tissue increases the resistance to insulin. Even a
small weight loss can be beneficial to many people with type 2
- Family history is also a contributing factor.
People with a parent or sibling with type 2 diabetes are more
likely to have the disease. Genes don't predetermine type 2
diabetes, but burden you with a predisposition to this disease.
People with a family history of either type of diabetes must
monitor diet, exercise, and lifestyle even more carefully than
people without this added risk factor.
- Age increases your risk, especially past the
age of 45. Perhaps it is because we tend to exercise less and gain
weight as we age. Perhaps the cells function less efficiently.
Whatever the reason may be, the longer you live, the greater your
- Stress and depression.
Another factor which can cause insulin production to malfunction is
persistent high levels of stress. A December 2005 Scientific
Americanan alysis of several research studies found that the stress
of racism and poverty causes many physiological consequences,
including increased insulin production and resulting increase of
type 2 diabetes. Perhaps that is one of the reasons why the rate of
type 2 diabetes in African Americans and Hispanics is twice that
for caucasians, and Native Americans have the highest incidence of
type 2 diabetes of all groups. Studies of caregiving also document
increased insulin production due to the stress of this burden.
Similarly, depression is a risk factor for type 2 diabetes.
Just like heart disease or certain cancers, probably all these
risk factors interact. Just because one of your parents may have
died of a heart attack does not necessarily mean that you will. But
it does increase the statistical probability. And conversely, just
because your family may have instilled in you a lifestyle of
healthy eating and abundant exercise doesn't mean that you will
never have type 2 diabetes. But your chances of a longer, healthier
life would be much better than for an obese person with a sedentary
Often we discover that we have type 2 diabetes after going to
the doctor for something else altogether. Both the American
Diabetes Association and the American Academy of Family Physicians
recommend a fasting glucose test after age 45, and if normal, every
3 years thereafter. You might want to begin screening earlier if
you have any of the risk factors above.
Complications, if type 2 diabetes is not controlled
- Retinopathy (eye damage).We have already
mentioned that uncontrolled type 2 diabetes can lead to vision
loss. The majority of people with diabetes will experience
deterioration in the blood vessels of the retina. Diabetes is the
leading cause of blindness of adults age 20 to 74.
- Nephropathy (kidney damage).Kidneys filter the
blood and eliminate waste excreted in urine, and diabetes can
damage this delicate system. Kidney damage is manifested in swollen
hands, feet, and ankles; anemia; shortness of breath; and high
blood pressure. Severe damage results in permanent loss of kidney
function and end-stage renal disease.
- Cardiovascular (heart and blood vessel)
disease.Diabetes significantly increases your risk of
heart attack and stroke. It may also lower your good cholesterol
(HDL) and raise your bad cholesterol (LDL).
- Infections.Glucose levels affect your immune
systems and ability to fight off bacteria and viruses, in addition
to impairing circulation to heal infected tissue.
- Neuropathy (nerve damage).Some people with
diabetes may eventually experience nerve damage. Numbness,
tingling, and that feeling that an area has "gone to sleep" are
signs of sensory nerve damage. Because extremities lose sensitivity
and injuries may go unnoticed, serious damage from minor sores or
abrasions can be a major problem, especially in the feet.
Treatment and Prevention
Gradual and permanent weight loss is probably the single most
effective treatment, as well as the best prevention. The preferred
and best way to do this is to slowly decrease your caloric intake
and, at the same time, increase your level of exertion. It may
sound simplistic, but the two major causes of type 2 diabetes in
seniors really are eating too much and exercising too little. The
best way to prevent it is to eat less and exercise more, but this
is understandably more difficult than it sounds in today's modern
Food is often much more than mere sustenance, and can be a
symbolic representation of love, comfort, family ties, and
celebration, so it is much more challenging to diet than is usually
acknowledged. In addition, with time consumed by work and
commuting, we often turn to unhealthy processed and fast foods. It
is far faster and easier to grab a ready-made pizza than create a
healthier one from scratch.
Today most of us in North America rely heavily on automobiles
for transportation and many of us live in areas where bicycles and
pedestrians are not as safe as cars. Europeans often walk to the
store, use public transportation a few blocks from home, and
frequently stroll for enjoyment, while we in the US increasingly do
not. And the fact that Americans typically spend significant hours
in front of the television and computer only adds to our growing
Start slowly with small but permanent changes. Cut out dessert
except for small portions at very special occasions, or stick to
sugar-free pudding with artificially-sweetened topping and fresh
fruit. Walk around the block daily. Over a period of weeks and
months add physical activities that you find easy to schedule on a
regular basis. Gardening and housework both count as exercise, and
walking briskly is the best of all. These activities need to be
maintained for the rest of your life.
As an example of how dramatic an effect such changes can have,
after my widowed father moved into assisted living and was
presented with healthier meal choices and opportunities to walk
more, his type 2 diabetes improved so much that he was able to stop
Working closely with your medical team is crucial. You will need
regular medical check-ups and perhaps even self-administered blood
tests daily. Technology now makes this relatively easy and
A nutritionist may counsel you in making dietary changes.
Generally speaking, people with diabetes are advised to increase
intake of vegetables and whole grains and to decrease animal fats
and sugars-just as we all should do. Those who drink should do so
in extreme moderation-no more than two alcoholic beverages daily
for men and half that for women.
Learn to de-stress your life. Try to schedule entire days where
you do only things that you enjoy. Relaxing practices such as
meditation, tai chi, yoga, and Nia (a dance form) can be very
effective in reducing daily stresses, as can having regular
Find trusted people you can talk to with confidence and
confidentiality, whether they are friends, family, or a paid
therapist. Studies have shown that people who meet with the same
small group of friends on a regular basis live longer and get sick
Consult your medical team about an exercise program. The
recommendations may surprise you. Once-typical advice used to
suggest an hour three times a week that included 5 minutes warm up,
20 minutes aerobics, 20 minutes upper and lower body weight
training, and 5 minutes stretching. This is now considered the bare
minimum. Current standards now urge exercising as much as 6 days a
week vigorously for at least an hour.
Be sure to start slowly and gradually. Working with a trained,
certified advisor-for example at a gym or senior center-may help to
get you started safely and effectively.
Many malls offer special walking times for older people,
enhancing exercise enjoyment with sociability and some
If diet and exercise are insufficient, numerous drug options
help manage type 2 diabetes in seniors. These medications can be
very expensive financially and can cause some potentially serious
physiological side effects. Work closely with your medical team and
contact your doctor immediately if you experience any nausea,
vomiting, abdominal pain, loss of appetite, dark urine, or
yellowing of your skin or the whites of your eyes.
Be especially alert for any negative drug interactions. Drugs
that are safe taken alone may combine dangerously with other
medications, including over-the-counter drugs. Be sure to inform
your doctor ofeverythingyou take, including non-prescription drugs.
Keep a close eye on all medications you take over a long period of
time. Our bodies' reactions to drugs change over time, and as we
age, even a drug that was safe for many years may produce a
negative reaction when you are older. We also change our tolerance
of recreational drugs such as alcohol and even caffeine.
Major commonly-used medications for type 2 diabetes:
- Sulfonylureas. This class of drugs is the mainstay of treatment
for type 2 diabetes. Sulfonylureas stimulate the pancreas to make
more insulin. People who respond best to this treatment are those
who were diagnosed before the age of 40 or have had the disease for
less than 5 years. Brand names include Orinase®,
Glucotrol®, DiaBeta®, Glynase®,
- Metformin, brand name Glucophage®. This medication
lowers blood glucose by decreasing output and reducing insulin
resistance. Extreme caution is advised if you have chronic
obstructive pulmonary disease, congestive heart failure, moderate
illness, or excessive alcohol use.
- Alpha-Glucosidase Inhibitors.Brand names Precose®
and Glyset®; this drug inhibits the breakdown of complex
carbohydrates. Use should begin gradually to minimize
- Thiazolidinediones, also called Glitazones. The most common
brand names are Actos® and Avandia®. These
drugs make your body tissues more sensitive to insulin. Side
effects include swelling, weight gain, and fatigue.
- Meglitinides, brand name Prandin®. Similar to
sulfonylureas, these are less likely to develop low blood sugar.
This drug works quickly, but is less long lasting than other
There are many other medications as well, and often these drugs
are used in combination. It is extremely important to find a
health-care provider to explain the advantages and disadvantages of
the different approaches to treatment so that you can fully
understand your options.
Living with Diabetes
Like many health conditions, prevention is the best cure. With
or without diabetes, make a commitment to life-long healthy
choices. If you have diabetes (and even if you don't, but are over
- Have an annual health maintenance exam
- Have an annual eye exam
- Have an annual dental exam
- Get needed vaccinations, especially an annual flu shot and
pneumovax at 65
- Don't smoke
- Take a baby aspirin daily
- Monitor your blood pressure
- Manage stress
- Take good care of your feet
It is one of the inequities of aging that as we get older, it
becomes more difficult to reach our toes, but toenails keep getting
thicker every year. Eventually a pedicure becomes a necessity
rather than a luxury. Most senior centers offer low cost footcare
from trained professionals. All this may sound overwhelming. But
following these recommendations can significantly reduce the risk
of premature death and unnecessary pain and suffering. Dealing with
diabetes is a life-long commitment. Keep in mind that a healthy
lifestyle is not only the best treatment; it's the best
Jeannette Franks, PhD, is a passionate gerontologist who teaches
at University of Washington and Bastyr University; she is the
author of a book on assisted living and numerous articles.