We all know an older person who has diabetes. Many people think that advancing age and diabetes are almost synonymous. But did you know that the way we treat diabetes in the elderly is often very different to how we treat it in a younger person. This is partially due to the other co-mobidities and illnesses that older people may suffer from but it is mainly due to altered physiology, different living environments and a need to focus on different priorities.
Individualised care. This is probably the single most important aspect of treating diabetes in the elderly. Some 70 year olds are still working a full day in an office or running their own, highly successful business, whilst others may already be a familiar face in a retirement home. The days of classing all people over the age of 60 or 65 in one basket are long gone!
Preventing hypoglycaemia. As we age, our body metabolism and physiology changes. One important change is in the kidney’s filtration function. the nett result of this is that the risk of glucose levels going low is much higher as we get older. This may necessitate a change in medication, different glucose targets and lifestyle adaptations to prevent lower than normal values. Hypoglycaemia can become a serious threat especially if it occurs unannounced at night.
Screening for cognitive impairment. No one likes to admit that there is a decline in the way we function. However, both advancing age and diabetes itself can cause mental decline and both are also strongly associated with illnesses such depression and dementia. The latest SEMDSA Guidelines published in 2017, recommend annual screening for these conditions and cognitive function in general in order to inform optimal diabetes management. At The Atrium Lifestyle Centre we are privileged to have a multi-disciplinary team available and as such this specialised screening can be done by out team members. Follow this link to read more about it.
A change in medication. As mentioned previously, various medications are metabolised differently in the body as we get older. Those drugs that promote insulin secretion may be contra-indicated in the elderly. If you haven’t changed your medications since you were on the other side of 60, now is a good time to seek specialised, professional help. Re-writing the same script year after year is hardly a useful task!
A change in lifestyle. Older people may change their eating habits and activity levels and this may lead to a change in medication requirements. Our bodies also become naturally more insulin resistant as we get older and therefore careful manipulation of therapeutic options may need to be considered.
Support and care. Often older people change their living environments – some may need assisted care, others no longer do their own cooking, some live alone whilst others continue to drive. All these circumstances may require special consideration when managing diabetes. We may also need to take into account more regular hospital and doctor visits, multiple specialists becomming involved in care and the impact of multiple medications on the body.
The bottom line is there is no one-size-fits-all. Diabetes in the elderly is NOT “easy to treat” and cannot be managed in combination with a list of other illnesses in a 15 minute consultation. It requires specialised care and careful planning to ensure that the individual is able to continue living to their fullest potential.