Today I want to blog on a topic that hits home with me. My grandmother was recently diagnosed with prediabetes, the condition before type 2 diabetes in which blood glucose levels are elevated but not enough for the person to be diagnosed with diabetes. I'd like to share with you some of what I told her.
An estimated 20 percent of people age 65 and older have diabetes — the highest percentage of any age group — and the number of older adults with diabetes is expected to grow in the coming years. One reason for this is that as our body ages, our pancreas simply makes less insulin. Another is lack of physical activity among older people — the resulting weight gain and reduced muscle mass can worsen insulin resistance.
Here's some information you should know if you are an older person with diabetes:
Glycemic control. There are no specific blood glucose guidelines for older adults with diabetes. The American Diabetes Association (ADA) guidelines are a good starting place: 90-130 mg/dL before meals and less than 180 mg/dL two hours after a meal. However, these guidelines need to be adjusted for each individual.
People who are expected to live another 10 years or more, who are cognitively intact, physically active, and can be responsible for their own diabetes self-management should follow the same glycemic guidelines as a younger person does (that is, meeting or exceeding the ADA guidelines). For those who don't meet the guidelines for tighter control, glucose goals are generally set higher.
Controlling cardiovascular risk factors. Research has found that uncontrolled blood pressure and lipids (cholesterol and triglycerides) are more likely to cause sickness or death in the older adult than uncontrolled glucose levels. But glycemic control is still important because older adults are still at risk for acute complications from hyperglycemia (when glucose levels are greater than 200-250 mg/dL).
One severe complication is hyperglycemic hyperosmolar coma (a metabolic disturbance where a coma can be present). Cognitive problems such as memory loss have also been linked to poor glycemic control.
Diabetes medications. Older adults can use many of the same medications for diabetes that younger adults do. But many of these same medications are not recommended for people with heart or kidney disease — two common conditions among older adults.
Metformin, for example, should not be used by people with renal insufficiency or heart failure; thiazolidinediones (TZDs) should not be used by people with congestive heart failure; and sulfonylureas may cause hypoglycemia. Insulin requires skill to draw up and inject and can also cause hypoglycemia. Medications should be addressed on an individual basis and older adults are typically started at the lowest recommended dose.
Bottom line: One size doesn't fit all when it comes to diabetes care. For older adults with diabetes, tight glycemic control generally takes third place to, first, controlling blood pressure and, second, controlling lipids. But this doesn't mean glucose levels can often be allowed to run high without causing problems. Also, different medications may be needed for older adults with diabetes. Talk with your doctor about this.
