Are you or a loved one at risk for Type 2 diabetes complications?
As people get older, their risk for Type 2 diabetes increases. Almost 50 percent of people with Type 2 diabetes are older than 60. In fact, in the United States about one in four people over the age of 60 has diabetes. Many people with diabetes are unaware they have the condition and may go years before they are diagnosed. This can be especially true for seniors, whose symptoms can be less apparent, overlooked as “normal aging” or not apparent at all.
Older patients with diabetes are a group distinctly different from younger adults. Older adults can have multiple co-existing conditions, and it is important to set treatment goals as needed. There is no “one-size-fits-all” treatment plan. If you or a loved one already has diabetes, you may find that you need to adjust how the condition is managed as the years go by.
Differences between Type 1 and Type 2 Diabetes:
Type 1 Diabetes – The body becomes unable to produce insulin. This type requires that a person inject insulin into their body to compensate. Most people who are affected are healthy when they develop Type 1 diabetes. It can affect both children and adults.
Type 2 Diabetes – The body becomes insulin resistant. It does not make enough insulin or use it well. This means cells can’t use the glucose as energy, so the glucose stays in the blood. Type 2 diabetes is more common than Type 1, especially in the elderly.
Having high blood glucose can cause problems like eye, kidney, nerve, and foot disorders. People with diabetes are also at higher risk for high blood pressure, heart disease and stroke, and other serious conditions. There is no cure for diabetes, but it can be managed. Balancing the diet with exercise and medicine (if prescribed) helps control weight and can keep blood glucose in the healthy range. This can help prevent or delay diabetes complications.
Signs & Symptoms
Some common symptoms of diabetes, like frequent urination and increased thirst may be harder to detect or absent with Type 2 Diabetes, especially in the elderly. Other commonly overlooked symptoms include:
- Lack of recognition of thirst with subsequent dehydration
- Blurred vision
- Increased depression
- Impaired cognitive function
- Extreme fatigue, nausea, vomiting
- Change in weight (loss or gain)
- Impaired physical function
- Greater number of injurious falls
- Cuts and bruises that are slow to heal
- Tingling or numbness in the hands and feet
- Increased incidence of pressure ulcers
- Increased infections of the bladder, skin, vaginal areas
The only way to be certain you or your loved one has Type 2 diabetes is to have a blood test ordered by the doctor. Screening every 3 years for anyone above age 40 is recommended or every year for individuals over 40 with other risk factors.
Once Diabetes is diagnosed, the goal is to keep blood sugar levels as close to normal as possible through diet, exercise and medications. People with well-managed blood sugar levels are at a much lower risk of developing complications. It is important that the person understand, as accurately as possible for their age, their disease and how to manage it. This will increase their active participation in their care – which is essential. The older the person gets, the more difficult it may become for them to manage diabetes on their own. Family members will have to decide if either part-time or full-time professional care is needed.
Possible complications of diabetes in the elderly
- Heart disease or stroke
- Kidney failure
- Nerve damage
- Reduced blood supply to the limbs, which could lead to amputation in extreme cases
- Restless leg syndrome
- Peripheral vascular disease and difficulties with circulation
- Vascular dementia
Diabetes puts the elderly at very high risk for vascular dementia (multi-infarct dementia). It is caused by one or more strokes. Strokes are blood clots that block one of the arteries supplying blood to the brain. If dementia is already present, this symptom of diabetes may be overlooked.
Blindness can result from poor blood sugar control. Unfortunately, by the time symptoms are recognized, there is often already major damage done. An annual eye exam with dilation of the pupils can often detect the problem before symptoms and damage appears. This is an essential part of diabetic care and recommended for anyone with a family history of diabetes.
Long-standing or poorly controlled diabetes can lead to nerve damage in the feet which can affect an elderly person’s balance and increase falls.
Taking care of diabetics
Day-to-day diabetic care is up to patients and their team of healthcare professionals. It includes:
- Choosing what, how much, and when to eat
- Staying active
- Checking blood glucose (if doctor prescribes it)
- Taking medicine (if doctor prescribes it)
- Not smoking
- Going to all medical appointments
- Learning all you can about diabetes
If you or a loved one has diabetes:
- Have a yearly eye exam
- Check cholesterol regularly
- Talk to a dietician or nutritionist that specializes in diabetes in the elderly regarding diet
- Ensure proper foot care
Management of diabetes in older adults by caregivers includes:
- Screening for and identification of barriers to diagnosis:
–Clinical / functional / psychosocial
–Depression, deconditioning, social isolation
- Management of hyperglycemia using:
- Management of risk factors:
–Cessation of cigarette smoking
–Low dose aspirin therapy
–Yearly screening for ACE inhibitors, vision problems, changes in the feet
- Modification of management plans takes into consideration:
–Cognitive dysfunction, physical disabilities
–Improve overall health goals and quality of life along with glycemic goals
Both caregivers and patients, should know the basics of diabetes management. Some excellent resources for learning more include: www.diabetes.org, American Diabetes Association website, which has many links to other sources; http://www.diabetes.org/assets/pdfs/living-healthy-with-diabetes-guide.pdf; http://www.caring-for-aging-parents.com/elderly-diabetes.html.
To inquire about in-home healthcare for diabetes from DTN Home Care, call 701.663.5373.
By Beverly Unrath, Vice President
Dakota Travel Nurse Home Care, Inc.