Taking Care of Elderly with Diabetes
Diabetes affects 26.8% or 14.3 million seniors over the age of 65 in the United States. In the state of Missouri alone, approximately 700,000 people are living with diabetes and many more have prediabetes, a condition where blood sugar is higher than normal. Although in many cases the disease can be controlled and even prevented, if left unmanaged diabetes will progress rapidly and carry higher risks of complications and premature death. This guide for CDS caregivers offers in-depth information about diabetes to help you provide the best possible care for your patient.
What is Diabetes?
Diabetes mellitus, commonly known as diabetes, is a chronic metabolic disease that causes high blood sugar or glucose.
Glucose is a type of sugar that can be found in carbohydrates. When you eat or drink, your body breaks down the carbohydrates and glucose is released into your bloodstream. As the blood sugar goes up, your pancreas releases insulin. This hormone enables cells throughout your body to absorb the sugar and use it for energy.
In addition, insulin helps balance your blood glucose levels. When there’s too much glucose in your bloodstream, your body will store the excess in the liver. The stored glucose is released once your blood glucose levels drop, for example, between meals or when you need a boost of energy.
If you have diabetes, your body doesn’t make enough insulin or any insulin at all. As a consequence, your pancreas can’t release the right amount of insulin when glucose enters your bloodstream. Glucose remains in your blood and never reaches the cells.
A blood sugar level of 126 mg/dL (7 mmol/L) or higher indicates that you have diabetes.
Diabetes-related health problems
Over time, high glucose levels in the blood can gradually damage organs and tissues. The longer someone lives with diabetes and the less controlled the blood sugar, the greater the risk of developing disabling and even life-threatening complications.
Possible diabetes-related health issues include:
- Heart disease
- Heart attack
- Coronary artery disease
- Nerve damage or neuropathy
- Kidney disease that can lead to kidney failure and require dialysis or a kidney transplant
- Eye damage that can potentially result in blindness
- Hearing impairment
- Dental diseases like gingivitis and periodontal disease
- Foot problems such as nerve damage in the feet or poor blood flow to the feet
- Skin conditions like bacterial and fungal infections
- Depression and anxiety
- Dementia, for example, Alzheimer’s disease.
Type 1 vs type 2 diabetes
The two most common types of diabetes are type 1 and type 2 diabetes. Although they are slightly different, both are serious conditions.
Type 1 diabetes
If you have type 1 diabetes, your body is not able to produce insulin. Your immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas, leaving you with little or no insulin.
Type 1 diabetes is usually diagnosed in children and young adults, although it is possible to get it at any age. People who have a parent or sibling with the condition and those who carry genes linked to the disease are at a higher risk of getting type 1 diabetes.
People with type 1 diabetes have to take insulin injections every day to control their blood glucose levels.
Type 2 diabetes
If you have type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well.
This type of diabetes can be developed at any age, but it usually affects older people. Type 2 diabetes represents 90-95% of diabetes cases in adults.
Type 2 diabetes results from a combination of genetics and lifestyle factors. The risk factors for developing the condition include:
- Being age 45 or older
- Being overweight
- Having a family history of diabetes
- Having a sedentary lifestyle with little physical activity
- Having had gestational diabetes during pregnancy
- Having prediabetes
- Having high blood pressure
- Having high cholesterol or high triglycerides
- Having polycystic ovary syndrome
- Having African American, Asian American, Hispanic, Alaska Native, Pacific Islander, or American Indian ancestry.
In many cases, type 2 diabetes can be managed by introducing lifestyle changes and taking medications. However, if these treatments are not successful in controlling blood glucose levels, it may be necessary to take insulin.
Other types of diabetes
Besides type 1 and type 2, there are several other types of the disease, including:
- Gestational diabetes. This is a form of diabetes that some women may develop during pregnancy. It usually disappears after giving birth.
- Common monogenic diabetes. This is a rare type of diabetes caused by a single gene mutation. It accounts for about 1-2% of all diabetes cases.
- Cystic fibrosis-related diabetes. Cystic fibrosis can cause scarring of the pancreas and prevent it from producing normal amounts of insulin. Just like people with type 1 diabetes, individuals with this condition are insulin deficient.
- Latent Autoimmune Diabetes in Adults (LADA), also known as late-onset diabetes. This is a slow-progressing form of type 1 diabetes that develops in adulthood.
Below, we take a look at the most common signs and symptoms of diabetes.
Signs of diabetes
The symptoms of diabetes vary depending on how much blood sugar is elevated. Some people, especially individuals with prediabetes or type 2 diabetes, may not have any symptoms at all, while people with type 1 diabetes tend to experience more severe symptoms.
The common signs of type 1 diabetes and type 2 diabetes include:
- Increased thirst
- Frequent urination (especially at night)
- Extreme fatigue
- Blurred vision
- Unexplained weight loss
- Sores and wounds take longer to heal
- Frequent gums or skin infections
- Presence of ketones in the urine.
How is diabetes diagnosed?
Diabetes is diagnosed by checking glucose levels in a blood test. A range of different blood tests is used to help diagnose diabetes, for example:
- Random plasma glucose test that can be given at any time during the day
- A1C test that is given at any time of the day and shows the average glucose level in the past three months
- Fasting plasma glucose test that is taken after fasting for at least eight hours
- Oral glucose tolerance test that is taken first after fasting overnight and once again two hours after having a sugary drink.
Diabetes in Seniors
Age is one of the main risk factors for type 2 diabetes. The older you are, the more likely you are to develop diabetes, due to a combination of increased insulin resistance and impaired function of the pancreas with age.
In addition, statistics show that diabetes impacts people of certain ethnic backgrounds more than others. According to the American Diabetes Association (ADA), the rates of diagnosed diabetes in adults with different backgrounds are as follows:
Non-Hispanic white individuals
Non-Hispanic black individuals
American Indians and Alaskan Natives
Prediabetes, also known as borderline diabetes, is a condition where your blood sugar is elevated but not high enough to be diagnosed as type 2 diabetes. This may be an indication that the long-term damage of diabetes affecting your heart, blood vessels, and kidneys, has already started. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.
People who develop type 2 diabetes usually have prediabetes first. According to the Centers for Disease Control and Prevention (CDC), around 86 million Americans—that is more than 1 in 3—have prediabetes, many without knowing it. Unlike diabetes, prediabetes often has no clear symptoms and may go undetected for years until serious health problems occur.
Fortunately, it is possible to prevent the progression from prediabetes to type 2 diabetes by introducing a number of lifestyle changes.
Tips to Reverse Prediabetes
If your patient has been diagnosed with prediabetes, there are several things they can do to delay or prevent the onset of type 2 diabetes.
Below, we list some lifestyle changes that can help the person you’re taking care of control their blood sugar level and keep it from increasing further.
Eat healthy diet
Eating a healthy, balanced diet is one of the best ways to reverse prediabetes. You should make sure that your patient eats a variety of vegetables, fruits, whole grains, low-fat dairy products, and lean proteins such as fish or chicken. At the same time, they should avoid processed, fried, or sugary foods and drink water instead of sweetened drinks.
Regular physical exercise is another essential part of diabetes prevention. The patient’s exercise routine should include at least 30 minutes of moderate physical activity, such as brisk walking, riding a bike, or swimming, five times a week. Ask the doctor what type of exercise level is safe for your patient.
Losing approximately 5-7% of the body weight can lower the risk for developing type 2 diabetes in overweight people. In order to keep the weight in a healthy range, it is important to introduce permanent changes to eating and exercise habits.
Can medications help treat prediabetes?
Your patient’s doctor may prescribe medication if they are at high risk for diabetes and have other medical conditions like obesity, a high triglyceride level, a low HDL cholesterol level, or high blood pressure.
Sugar-lowering drugs for diabetes such as metformin (Glucophage, Glumetza, and Fortamet) may reduce the risk of type 2 diabetes. However, healthy lifestyle choices including diet and exercise remain essential in reversing prediabetes.
Read on to find out more about the available diabetes treatments.
Treatment for Diabetics
Type 1 diabetes
The main treatment for type 1 diabetes is insulin which replaces the hormone that the body is not able to produce. The most commonly used types of insulin include:
- Short-acting insulin (Humulin R, Novolin R) that takes effect and wears off more quickly than other insulin types
- Rapid-acting insulin (Apidra, Humalog, Novolog) that acts quickly to minimize the rise in blood sugar after eating
- Intermediate-acting insulin (Novolin N, Humulin N) that has delayed absorption but stays effective for up to 18 hours
- Long-acting insulin (Lantus, Toujeo Solostar, Levemir, Tresiba) with effects lasting an entire day
- Premixed insulin, a combination of two insulins: one that helps the body control blood sugar throughout the day and another that allows to control blood sugar at mealtimes.
How is insulin administered?
It is not possible to take insulin orally because stomach enzymes would break it down before it reaches the bloodstream, preventing its action. Insulin is administered either through injections or an insulin pump. Another option is a closed-loop insulin delivery, where the implanted device links a continuous glucose monitor to an insulin pump. The device automatically delivers the correct amount of insulin when needed.
Additional medications also may be prescribed for people with type 1 diabetes. These include high blood pressure medications, cholesterol-lowering drugs, and aspirin for patients with an increased risk of heart disease.
Type 1 diabetes treatments should be accompanied by healthy lifestyle choices such as eating a balanced diet, exercising regularly, and maintaining a healthy weight.
Type 2 diabetes
In most patients with type 2 diabetes, diet and exercise can help control and manage the disease. Your patient’s health care team will create a management plan that includes:
- Healthy nutrition
- Physical exercise
- Testing blood sugar frequently
- Tracking glucose levels
These steps will help keep their blood sugar level closer to normal, which can delay or prevent complications. However, if lifestyle changes alone aren’t enough to lower blood sugar, it may be necessary to take medications. Some people who have type 2 diabetes also need insulin therapy.
Although there is no cure for diabetes, it is possible to take steps to manage the disease and stay healthy.
Staying Healthy with Diabetes
With the right treatment and care, your loved one can live a healthy life with diabetes. Here are several things they can do to minimize the risk of developing diabetes-related complications:
Manage blood pressure
The combination of high blood pressure and type 2 diabetes greatly increases the risk of having a heart attack or stroke. Some patients may need to take medications to keep their blood pressure below 130/80 mm Hg.
People with diabetes often have high levels of “bad” (LDL) cholesterol and higher levels of triglycerides that can lead to heart disease and stroke. It may be necessary to adjust eating and exercise habits and/or take medications to ensure healthy cholesterol levels.
Focus on healthy eating
Making healthy food choices, knowing how to read food labels, and limiting portion sizes are key to maintaining the optimal weight and managing diabetes.
Stay physically active
Aerobic and resistance exercises are both important for people living with diabetes. A minimum of 150 minutes of moderate to high-intensity aerobic exercise per week can help control the disease and minimize the negative health consequences of diabetes.
Maintain healthy weight
Reaching and maintaining a healthy weight can help your patient control their blood sugar, blood pressure, and blood fat levels. Being overweight or obese makes it hard to manage the disease, in addition to increasing blood cholesterol and blood pressure. These conditions are the main risk factors for cardiovascular disease, which is the leading cause of death for people with diabetes. In order to lose weight, it is important to eat fewer calories than are used up through normal metabolism and physical activity.
Schedule yearly eye exams
Doctors recommend that adults with diabetes get an annual eye exam to check for diabetes-related eye diseases such as retinopathy or diabetic macular edema.
People with diabetes who smoke have an increased risk of heart disease, eye disease, stroke, kidney disease, blood vessel disease, and nerve damage. Smoking can also decrease good cholesterol, temporarily raise blood pressure, cause blood clots, and make it more difficult to exercise. People who smoke are more likely to have increased blood sugar levels, making it harder to control their diabetes, and three times more likely than nonsmokers to die prematurely of heart disease or stroke.
Your patient can ask their doctor for help to quit smoking or call 1-800-QUITNOW (1-800-784-8669).
Reduce alcohol intake
Alcohol can influence blood glucose levels and make it more difficult to control blood sugar. The American Diabetes Association recommends that both men and women over the age of 65 should have no more than one alcoholic drink per day. It is also important to check blood sugar levels before drinking. Patients who use insulin or take diabetes medications should avoid drinking on an empty stomach.
Schedule yearly kidney exams
High blood sugar levels can potentially damage the blood vessels in the kidneys. An estimated 30% of patients with type 1 diabetes and 40% of those with type 2 diabetes suffer from kidney failure. It is important to have urine tested regularly for early signs of kidney disease. Your patient’s doctor may prescribe medications that will delay further damage to their kidneys.
Take care of teeth and gums
High blood sugar levels can impact oral health, leading to plaque buildup and increased risk of gingivitis and advanced gum disease. Your patient should brush their teeth twice a day and floss at least once a day, in addition to getting regular dental checkups every six months.
Get flu and pneumonia vaccine
Flu and pneumonia pose a much higher risk for people with diabetes because elevated blood sugar impairs white blood cells’ ability to fight infections. That’s why doctors recommend anyone with diabetes over the age of 65 get the flu and pneumonia vaccine.
Protect the skin
Diabetes can cause skin disorders such as diabetic dermopathy, bacterial and fungal infections, and vitiligo. Proper skin care, including keeping skin dry and taking care of cuts and bruises to prevent infections, is essential for reducing the risk of skin-related problems.
Diabetes can cause various foot-related problems, such as diabetic neuropathy or nerve damage and peripheral vascular disease that affects blood flow. Ingrown toenails, cuts, and sores on the feet can lead to serious infections and proper foot care is essential when living with diabetes. Your patient should see a podiatrist if they have red patches, sores, blisters, breaks in the skin, infections, or calluses on their feet.
Keep up with cancer screenings
People with diabetes are at increased risk for both liver, pancreatic, colorectal, breast, and bladder cancer. They should check with their healthcare provider which cancer screenings to get based on their age, gender, and other risk factors.
Blood sugar levels increase with stress. As part of diabetes management, it is important to find ways to relieve stress, such as deep breathing, practicing yoga, or engaging in a relaxing hobby.
Manage depression and anxiety
People with diabetes often experience stress and anxiety. However, untreated mental health issues can make it much more challenging to follow a diabetes care plan. Lifestyle changes as well as therapy or medication can help reduce that patient’s stress and anxiety levels.
Manage blood sugar
Your patient’s healthcare team will set goals for their blood sugar levels. The blood glucose levels should be kept as close to normal as possible to delay or prevent complications. In general, the targeted daytime glucose levels before meals are between 80 and 130 mg/dL (4.44 to 7.2 mmol/L) and after-meal levels up to 180 mg/dL (10 mmol/L). A blood glucose meter will help track blood sugar levels.
Some people may need to use medications and/or insulin in addition to introducing lifestyle changes, like balanced nutrition and increased physical activity, to achieve specific blood sugar targets.
Contact medical team with questions and concerns
Your patient’s health team will make a yearly assessment of their diabetes management plan. This plan may change over time, and they may need increased support and more information. In addition, any change in their health condition such as a new diagnosis or a change in care may also require modification in the diabetes management plan. If you think your patient has any concerns or might need help with their diabetes management plan, encourage them to talk to their doctor.