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Type 2 Diabetes in Seniors

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 serious risk.

Risk Factors

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 above.

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 diabetes.

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 risk.

Another factor which can cause insulin production to malfunction isstress. 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 whites, and American Indians 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 lifestyle.

Diagnosis

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 world.

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 the United States 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 inactivity.

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 his medication.

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 painless. 

 

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 massages.

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 less often.

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 shopping.

Medications

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®, and Micronase®.
  • 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 flatulence.
  • 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 medications.

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 50):

  • 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 prevention. 

 

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.

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