November is American Diabetes Month
More than half of the 16 million Americans estimated to have diabetes are over the age of 60. Of those over 65, according to a NIH study, almost 1 in 5 has Type 2 diabetes. Although this disease is very common, it is also very serious; however, it can be managed and is sometimes preventable, but certain group-specific characteristics present new challenges to health care professionals treating older adults with diabetes due to age-related impairment of cells in the pancreas, loss of lean tissue and accumulation of fat, particularly intra-abdominal fat, and a decreased tissue sensitivity to insulin. In 2008 there were about 24 million people with diabetes in the US alone, from those 5.7 million people remain undiagnosed. Another 57 million are estimated to have pre-diabetes (a slightly elevated blood sugar), which puts them at risk for developing the disease according to the ABA. The millions of Americans who are affected with this disease are also at risk for complications– increasing healthcare costs and hospitalizations.
What is Diabetes? Diabetes is a group of metabolic diseases where a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. To put it simply, your body changes the foods you eat into glucose. This glucose travels through your blood stream, fueling or feeding your cells. Insulin is a hormone that helps our body convert glucose into energy. If your body doesn’t produce insulin or doesn’t use it properly, your blood sugar rises. With diabetes, you may feel tired, hungry, or thirsty; you may lose weight, and the high blood sugar can harm your eyes, kidneys, and nerves. Heart disease, strokes, and amputation and many other complications can result from severe diabetes.
Diabetes is also hereditary. Your family background weighs heavily in the risk that you may develop diabetes. The more you are at risk, the more important it is that you understand the disease, look for the symptoms and see your physician on a regular basis. In the US, there is a lot of research underway and according to the NIH, “Careful control of blood glucose, blood pressure, and cholesterol can prevent or delay diabetes and its complications.” There is other evidence that points to the lack of an early diagnosis.
There are two types of diabetes, excluding Gestational diabete–when a pregnant women, who has never had diabetes before develops high blood glucose levels during pregnancy.Type 1 diabetics must take insulin every day. This is often seen in children, teenagers, or adults under 30. Type 2 diabetes results from insulin resistance where the cells don’t use the insulin properly and this normally occurs in older adults. Diabetes Type 2 is usually linked to obesity, lack of activity, and family background. Type 2 diabetics often go through a condition called “pre-diabetes” in which their blood sugar is elevated, but not high enough to be called diabetes. With this condition, the risk of acquiring Type 2 diabetes is high, and heart disease and stroke risks are greatly increased.
Very high or very low blood glucose levels can lead to serious medical problems and emergencies. Diabetics are prone to go into a coma if their blood glucose gets too high. Low blood glucose, known as hypoglycemia can lead to other complications, if left untreated.
Hypoglycemia is usually mild and can be treated by eating or drinking something with carbohydrates such as bread, fruit, potatoes, or milk. However, if untreated, hypoglycemia can lead to loss of consciousness and may be life threatening. Those with diabetes also have an increase risk for Alzheimer’s disease. Studies are currently underway to determine if strict controls of glucose can delay or prevent the symptoms of Alzheimer’s disease.
What are the symptoms, and how are they managed?
Type 1 diabetics may have few or no symptoms. Many don’t know they have it. For others, feeling tired and rundown is the only symptom. Some may feel very thirsty, urinate often, have a loss of weight, blurred vision, get skin infections, or heal slowly from cuts or bruises. Any of these symptoms should be reported to your physician to insure you are not carrying this silent killer. Your physician can order specific lab tests. A fasting plasma glucose test is taken after fasting for at least eight hours and will measure your blood glucose level. Oral glucose tolerance tests will test your blood glucose levels but then you are given a sugary beverage and your blood glucose level is checked at 1, 2, and 3-hour intervals. Managing your diabetes is of utmost importance, however in older adults, several factors may affect good control.
Meal planning and eating properly are the key to managing blood glucose, blood pressure, and cholesterol levels. You must understand how different foods affect your blood sugar levels. A good meal plan takes into account likes and dislikes, goals for weight control and daily physical activity. Daily physical activity is very important in helping with diabetes maintenance. Taking part in a regular fitness program can improve your situation. However some of these lifestyle modifications may be difficult for seniors because of lack of means and access, and the decline in their physical abilities, which may make it more difficult to increase their activity. Years of smoking may make quitting very difficult, but the treatment goals are the same for everyone who has diabetes–to enhance their quality of life and reduce complications from this disease, whether active and healthy, or for those who are frail and disabled.
According to the ABA, about 57% of adults take oral medications. Some medications do have side effects, which range from nausea, respiratory infections, diarrhea, and headaches to liver failure. Medications are important, however, in controlling diabetes for many people. Your physician may prescribe oral medications, insulin, or a combination of the two. Others with Type 2 diabetes can avoid the need for medications by maintaining their glucose levels, blood pressure, and cholesterol goals by meal planning and engaging in an exercise program.
If you have diabetes, it is important to have regular eye exams, a kidney test for albumin, a protein that indicates whether the kidneys have been affected or not (usually obtained through getting a urine sample). People with diabetes should check their feet every day and watch for redness or patches of heat. A podiatrist or a family physician should check sores, blisters, or breaks in the skin, infections, or build-up of calluses right away.
Get help from Medicare
Older adults with diabetes on Medicare are covered for glucose monitors, test strips, and lancets. If you need more information about this program, please call 1-800-MEDICARE (800-633-4227). The good news about a bad disease is that there is a lot you can do to live with, manage, and in some cases, even reverse diabetes.
Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email her at firstname.lastname@example.org or visit www.sanitasole.net for more information. Phone: 239.394.9931.