Last Updated: April 9, 2015
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 than
we did then. Nevertheless, the disease has reached epidemic
proportions in the U.S., afflicting more and more people at younger
and younger ages.
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 the need for amputation. Type 2
diabetes in seniors is particularly problematic.
Type 2 Diabetes 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.
Type 2 diabetes is frequently asymptomatic for many years,
before initial tell-tale signs of the disease emerge. These
- Flu-like Fatigue
Feeling lethargic, tired or chronically weak can be a sign of type
2 diabetes. When your body can't process sugar properly, you'll
have chronically low energy.
- 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
- 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
- Sores That Heal Slowly or Frequent Infections
Urinary tract infections are especially a problem for
- Numbness & Tingling in Extremities
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
How Type 2 Diabetes Affects the Body
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
Type 2 Diabetes Risk Factors
You may be at risk for developing diabetes if you have any of the
- Extra Weight
Excess fatty tissue increases the resistance to insulin.
Even a small weight loss can be beneficial to many people with type
- Family History of the Disease
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
- Age Over 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 & 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.
It's likely that all of these factors interact. While having one
risk factor may not make it likely that you'll develop the disease,
if you have three or four risk factors, you'll need to be extra
vigilant about maintaining a healthy lifestyle.
Type 2 Diabetes Diagnosis & Potential Complications
Often people discover that they 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)
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 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).
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
Natural Treatment & Prevention of Type 2 Diabetes
If you feel you may be at risk for developing type 2 diabetes,
or you've been newly diagnosed, there are several simple things you
can do to help manage your health:
- Lose Weight
This may sound simplistic, but the two major causes of type 2
diabetes in seniors 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
- Eliminate Fat & Sugar from Your Diet
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
- Eliminate Stress
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 massages.
Medications for Type 2 Diabetes
If diet and exercise are insufficient, numerous drug options
help manage type 2 diabetes in seniors. Major commonly-used
medications for type 2 diabetes:
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®,
Glynase® and Micronase®.
- Metformin, Brand Name
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 flatulence.
- Thiazolidinediones, Also Called
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,
- Meglitinides, Brand Name
Similar to sulfonylureas, these are less likely to develop low
blood sugar. This drug works quickly, but is less long lasting than
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.
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