Diabetes in Older Persons - Fighting isolation, poverty, neglect
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Diabetes
in Older Persons
Fighting isolation,
poverty, neglectDiabetes in Older Persons
Fighting isolation,
poverty, neglect
Mission
To work for the cause and care of disadvantaged aged persons and to
improve their quality of life
HelpAge India is thankful to the following expert for the preparation
of this manuscript:
Dr. Ashok Jhingan
Chairman
Delhi Diabetes Research Centre
J-136, Rajouri Garden,
New Delhi 110027.
Series Editor
Anupama Datta
Deputy Director (R&SD)Diabetes in Older Persons
What is Diabetes ?
Diabetes mellitus, commonly referred to as diabetes, is a medical
condition associated with abnormally high levels of glucose (or sugar) in
the blood (hyperglycaemia). Glucose comes from the digestion of
starchy foods such as bread, rice, potatoes, chapattis , from sugar and
other sweet foods, and from the liver which makes glucose. Glucose is
used by the body to make energy.Normally, blood glucose levels are
tightly controlled by insulin, a chemical (hormone) that is produced by a
gland near stomach called the pancreas. Insulin lowers the blood
glucose level because it stimulates the body to make use of glucose.
When the amount of glucose in the blood increases, for example, after
eating food, insulin is released from the pancreas to normalize the
glucose level. However, in patients with diabetes , the elevated glucose
levels cannot be normalized either because of complete absence of
insulin, or because insulin is insufficient, or inspite of sufficient insulin
being produced, the body is resistant to it. This causes abnormally high
levels of blood glucose, which ultimately leads to the presence of
glucose in the urine (glucosuria).
What are the common types of Diabetes?
There are two main types of diabetes mellitus. These are known as type 1
and type 2 diabetes.
Type 1 diabetes:
Type 1 diabetes mellitus used to be called insulin-dependent diabetes
mellitus, or juvenile-onset diabetes mellitus, because it usually begins in
childhood or adolescence. Type 1 diabetes occurs when the body's
immune system attacks insulin-producing beta cells in the pancreas and
3Diabetes in Older Persons
destroys them. As a result there is absolutely no production of insulin in
the body. These patients therefore rely completely on treatment with
insulin for their survival. Approximately 5-10% of Diabetics have Type I
Diabetes. It usually occurs in children or young adults, though it can also
develop in older adults. This disorder increases the risk of
cardiovascular disease, blindness (retinopathy), nerve damage
(neuropathy) and kidney damage (nephropathy).
Type 2 diabetes:
Type 2 diabetes mellitus is the most common form of diabetes. It used
to be called non-insulin dependent diabetes mellitus, or adult onset
diabetes because it usually begins in adulthood. It develops when the
body can still make some insulin, but not enough, or when the insulin
that is produced does not work properly (known as insulin resistance).
In most cases this is linked with being overweight and leading a
sedentary lifestyle. If neglected, obesity-linked Pre-Diabetes can lead to
the onset of Type 2 Diabetes. This type of diabetes usually appears in
people over the age of 40, though , it often appears after the age of 25.
However, recently, more children are being diagnosed with this
condition, some as young as seven (early onset type 2 diabetes). Type 2
diabetes is the most common of the two main types and accounts for
between 85 - 95% of all people with diabetes. This condition can only be
managed, not reversed, for the rest of a person's life.
Pre diabetes
4Diabetes in Older Persons
This is a condition that occurs when a person's blood glucose levels are
higher than normal, but not high enough for a diagnosis of type 2
Diabetes. Before an individual develops Type 2 Diabetes, they are
almost always Pre-Diabetic. Insulin Resistance and obesity are
underlying causes of Pre-Diabetes, It is mostly seen in patients who
have a strong family history of diabetes and are obese(overweight) or
lead a sedentary lifestyle. Such people need regular screening for
diabetes, preferably a Glucose Tolerance Test annually, along with strict
diet control and lifestyle modification. Taking action to manage your
blood glucose levels when you have Pre-Diabetes can prevent or delay
Type 2 Diabetes from ever developing.
Diabetes Mellitus is a life-long, chronic condition.
• Type 1 diabetes usually begins in childhood or adolescence. The
symptoms tend to occur suddenly after the onset of the disease and
are usually more obvious than those of type 2.
• Type 2 diabetes usually begins in adulthood (mainly after 30-35
years of age). It develops gradually in most cases and may be
present for several years before it is detected
How serious is Diabetes?
The early symptoms of untreated diabetes mellitus are related to the
elevated blood glucose levels. Excess glucose in the blood ultimately
results in high levels of glucose being present in the urine (glucosuria).
This leads to increased urination, especially in the night, which leads to
dehydration and increased thirst. Other symptoms include extreme
tiredness, weight loss, excessive hunger, blurred vision, itchy skin and
repeated minor infections such as thrush and boils.
5Diabetes in Older Persons
If uncontrolled for many years, diabetes mellitus can lead to more
serious health problems also called the complications of diabetes.
These include:
• Blood vessel damage within the eye (retinopathy). This can start
as blurring of vision and finally lead to blindness.
• Kidney disease (nephropathy) or kidney failure.
• Nerve damage (neuropathy) especially of the hands and feet,
causing tingling, numbness, burning sensation in the feet or
hands. Few patients have sensations of walking on sand or
cottonwool and falling of chappals from the feet in advanced
nerve damage. Affection of the nerves of the heart can lead to
silent / painless heart attack.
• Narrowing of the blood vessels due to fatty deposits
(atherosclerosis). This increases the risk of heart attack, stroke
and poor blood flow in the legs.
• Sexual problems due to the involvement of nerves.
Who can get diabetes?
Anyone can develop diabetes, but some people are more at risk than
others. You are at greater risk for diabetes if you:
• Are over 45 years old.
• Are overweight.
• Have a family history of diabetes.
• Have high cholesterol and/or high blood pressure.
6Diabetes in Older Persons
• Have had gestational diabetes during pregnancy.
• Have given birth to a baby that weighed more than 4 kg.
• Lead a sedentary lifestyle.
• Exercise less than 3 times a week.
While you cannot change some of these factors, you can change others.
For example, you cannot change your age or ethnicity, but you can
exercise more often. These kinds of changes will help reduce your risk of
developing diabetes.
What are the symptoms of diabetes?
Diabetes often has no symptoms or warning signs. The only way to be
sure is to have your blood tested for glucose (blood sugar). If symptoms
do appear, they might include:
• Feeling tired
• Feeling irritable
• Urinating more than normal
• Being very thirsty
• Being very hungry
• Unexplained weight loss
• Some wound that is not healing
• Blurred vision
• Tingling, numbness or burning in feet or hand
If you are experiencing some of these symptoms or think that you might
be at risk for diabetes, be sure to talk to your doctor about getting
tested.
How is Diabetes treated?
Treatment is aimed at controlling the elevated blood glucose without
causing an abnormally low glucose level (hypoglycaemia). An important
aspect of your treatment plan will involve eating a healthy diet (low fat,
salt and sugar and high fibre). You should also monitor your blood
7Diabetes in Older Persons
glucose levels regularly as well as undergo routine timely screening to
rule out complications.
• Type 2 diabetes mellitus is first treated with weight reduction, a
healthy diet and regular exercise.
• In type 2 diabetes, if the above measures fail to control the
elevated blood glucose, oral (by mouth) medicines are used to
try to boost insulin production, improve the body's use of it, or
reduce the speed at which glucose enters the blood. Treatment
with insulin will be considered if these other medicines are
insufficient or in the presence of complications.
Treating high blood pressure and controlling the levels of fats (lipids) in
the blood are also very important in patients with diabetes as they are at
greater risk than the normal population of developing serious
cardiovascular diseases
.Although there is currently no cure for diabetes mellitus, it can be
controlled successfully with an active treatment plan.
New treatment options :
1. Insulin Pens: These pen devices are very successful these days
due to easy and relatively painless injection of insulin and are
very to carry around while travelling.
2. Insulin spray : This is another novel way of insulin delivery,
where insulin can be inhaled in the form of a spray through
aerosol inhalers , much like the inhalers used by asthmatic
patients.
8Diabetes in Older Persons
3. Insulin Pumps : The insulin pump is a pager-sized device that
continuously delivers insulin in small amounts all through 24 hrs
through a small painless cannula that is inserted under the skin .
4. Pancreas transplant & Islet cell transplant: Though these have
been tried in the western countries, still their long-term results
are awaited.
5. Stem cell therapy :This is again a new and promising therapy,
and its success report is much awaited.
Diabetes Prevention.
Diabetes is a disease of lifestyle. So, change your lifestyle before
diabetes changes you.
Healthy eating and exercise habits are the best way to prevent diabetes.
These are also great ways to help keep diabetes in control if you already
have it.
To eat healthy, pick foods that are nutrient-rich. This means that they
have many vitamins, but not much fat or sugar. When it comes to foods
that are high in sugar, like ice cream or cookies, make sure that you are
not overeating. You can still eat these foods, but eat them in
moderation.
9Diabetes in Older Persons
Exercising regularly, atleast 5 times a week, is another way to lower your
risk of developing diabetes. For example, you might go for walks, run,
bike, swim, join a local sports team or try a dance class. The key here is
to start small and find something that you enjoy. Leading an active life
not only is good for your sugars, but also for your heart and mind!!
The mantra to a healthy life with diabetes is:
Lose weight - Gain Life !!
Eat right & Exercise..!!
Yoga and meditation.
Yoga and meditation are also of great use in controlling your diabetes.
While Yoga cannot “cure” diabetes, it can complement the lifestyle
changes necessary to keep diabetic symptoms in check, and it can help
you feel more in control of your health and well being. Yoga exercises
gently tone and shape the body, improve posture and flexibility, and
contribute to feelings of well being. Most Yoga exercises have a
profound effect on improving circulation, especially to the extremities.
Yoga exercises help keep the blood vessels elastic, and Yoga exercise
combined with relaxation training has even been shown to reduce high
blood pressure in some cases. After you've practiced for a while, you can
add more vigorous exercises to your Yoga routine to give you the added
benefits of some aerobic conditioning and increased muscle strength.
Yoga exercises gently press on the body's glands and organs, resulting in
positive effects for the digestive, endocrine, and reproductive systems.
By releasing muscle tension and teaching you how to relax at will, Yoga
relaxation training helps reduce the harmful effects of physical and
mental stress. Daily practice of meditation shows you a quiet, restful,
stable part of yourself that supports everything you do, and teaches you
10Diabetes in Older Persons
how to draw on these inner resources for the strength and health that
can be your choice.
Side Effects of Diabetes Treatment.
Medications used for the control of diabetes are usually considered safe
, though a few rare side effects are worth mentioning.
• Some people can have drug allergy or rashes with some tablets
that belong to the sulfa group.
• Some people suffer from gaseous distension, flatulence or
stomach upset with metformin group of drugs.
• A serious side effect of medications used to control diabetes is
hypoglycemia or low blood sugar as we call it in simple terms.It
is a very important condition and so we must know a few
important details about it as mentioned below .
Hypoglycemia: A Common Side Effect of Diabetes Medications
Hypoglycemia can occur in people with diabetes who take certain
medications to keep their blood glucose levels in control. Usually
hypoglycemia is mild and can easily be treated by eating or drinking
something with carbohydrate. But left untreated, hypoglycemia can
lead to loss of consciousness.
Causes of Hypoglycemia
In people taking certain blood-glucose lowering medications, blood
glucose can fall too low for a number of reasons:
• meals or snacks that are too small, delayed, or skipped
• excessive doses of insulin or some diabetes medications
• increased activity or exercise
• excessive drinking of alcohol
11Diabetes in Older Persons
Symptoms
Symptoms of hypoglycemia include
• hunger
• nervousness and shakiness
• perspiration
• sleepiness , confusion
• difficulty in speaking
• feeling anxious or weak
• dizziness or light-headedness.
Hypoglycemia can also happen while you are sleeping. You might
• cry out or have nightmares
• find that your pajamas or sheets are damp from perspiration
• feel tired, irritable, or confused when you wake up.
Prevention
To help prevent hypoglycemia, you should keep in mind several things:
Diabetes medications: Always take medications and insulin in the
recommended doses and at the recommended times. Regular
monitoring of blood sugars and adjustment of doses of your
medications by your doctor can really help in preventing your sugars
from going too low.
Meal plan : Eat regular meals, have enough food at each meal, and try
not to skip meals or snacks.
Exercise : You should always have a snack or adjust your medication
before vigorous exercise. Discuss with your doctor about the type and
duration of exercise best suited for you.
Alcohol : Drinking, especially on an empty stomach, can cause
12Diabetes in Older Persons
hypoglycemia, so, if you want to drink always have a snack or meal at
the same time.
Treatment
If you feel any symptoms or think your blood sugar is low, use a blood
glucose meter to check your level. If it is 70 mg/dL or below, take
glucose, candy, fruit, sugar , honey or a cup of milk immediately to raise
your blood glucose.
After 15 minutes, check your blood glucose again to make sure that it is
no longer too low. If it is still too low, have another serving. Repeat these
steps until your blood glucose is at least 70. Then, if it will be an hour or
more before your next meal, have a snack.
If you take insulin or a diabetes medication that can cause
hypoglycemia, always carry one of these quick-fix foods with you.
Wearing a medical identification card about your diabetic status is also
a good idea.
Care of a person suffering from diabetes
If you already have diabetes, you can lessen your chance of developing
complications by keeping your blood sugar under control. Some ways to
do this are to:
• Check your blood sugar often.
• Ask your doctor about a blood test called “hemoglobin A1C.” This
tests how your normal blood sugars have been over the past 2 or
3 months. It is a kind of “report card” for your blood sugar.
• Follow your doctor's advice about oral medicines or insulin
injections, diet and exercise.
13Diabetes in Older Persons
• Monitor your cholesterols/ lipid profile. Increased lipids are bad
for your heart, and along with uncontrolled sugars, can
• lead to major heart problems.
• Monitor your blood pressure. If your blood pressure is high, talk
to your doctor about taking steps to control it.
• Have your doctor check your urine for protein to keep an eye on
your kidney status. He can put you on certain kidney-protective
medicines that save your kidneys from the effects of high blood
sugars.
• Get your eyes checked routinely, at least once a year, to pick up
diabetic eye changes. Ask for a retinal checkup which differs
from a routine vision check that you normally do for your
glasses. If picked up early, these changes are still reversible, but
once severe changes develop, you might need laser treatment.
• Screen routinely for nerve affection. Checking for vibration
thresholds in nerves of your feet can help you pick early sensory
changes in nerves due to diabetes.
• Last but not the least, eat healthy and exercise regularly. These
simple steps go a long way in making your life with diabetes
much more comfortable and healthy.
Coping with diabetes does not mean giving in to an “illness” mentality;
by following your physician's instructions and changing your lifestyle,
you can create a life that is full, happy, energetic, healthy, and balanced.
14Disclaimer:
This booklet is not intended to be a substitute for professional medical advice.
If in doubt, please consult your doctor and follow his/her instructions. All the
statements have been made by the contributors in their individual capacity.
15Follow your physician's instructions and
change your lifestyle to create a life
that is full, happy, energetic and healthy
Fighting isolation,
poverty, neglect
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