Managing Diabetes in Older Adults

• Gain insight into managing diabetes in the elderly.
• Data indicates that around 33% of individuals aged 65 and above have diabetes.
• Diagnosis of diabetes in older adults is often delayed as symptoms can be mistaken for age-related conditions.

As the population continues to age, the prevalence of diabetes among elderly adults is also increasing. The Endocrine Society estimates that 33% of people 65 years old and older have diabetes.

The elderly population is at a higher risk of experiencing complications associated with diabetes, such as hypoglycemia, kidney failure, and heart disease, compared to younger adults with the condition. Older adults also are more prone to hospitalization due to these complications and often have one or more concurrent conditions that can affect the management and education of diabetes. 

Signs of Diabetes in Older Adults

Thirst and Urination 

Diabetes leads to an accumulation of excess sugar in the blood, prompting the kidneys to work overtime. As the kidneys strive to filter sugar, excess sugar is expelled through urine, depleting bodily fluids. Consequently, individuals may experience increased thirst and more frequent urination. 

Excessive Fatigue 

Elevated blood sugar levels make it more challenging for the body to convert sugar into energy, contributing to fatigue. Dehydration associated with diabetes could also cause fatigue.

Delayed Wound Healing

Injuries may take longer to heal. The development of sores, particularly on the feet, and unresolved skin infections, could also indicate slowed circulation due to high blood sugar, hindering the body’s natural healing processes. Women with diabetes may also encounter frequent bladder infections and vaginal yeast infections.

Dizziness and Fainting

Elderly individuals with diabetes may experience episodes of low blood sugar, known as hypoglycemia. This can lead to weakness, dizziness, tremors, confusion, or fainting. Each hypoglycemic episode heightens the risk of cardiovascular-related fatality and can exacerbate cognitive function decline or escalate dementia. Consuming fruit juice or sugar tablets can elevate blood sugar levels again.

Headaches

The brain requires a consistent supply of sugar to function optimally, which is not always compatible with the fluctuations in blood sugar levels associated with diabetes, potentially causing headaches.

Tingling Sensation in Hands and Feet

Nearly half of individuals with diabetes experience nerve damage, particularly those with long-standing diabetes. This condition, known as peripheral neuropathy, can result in tingling, numbness, weakness, or pain in the extremities.

Blurred Vision

Elevated blood sugar levels can draw fluid out of the eye lenses, making it difficult for individuals with diabetes to focus. If left untreated, this can lead to vision loss.

Gum Issues

Red, swollen, and painful gums are another symptom of diabetes. This is due to diabetes compromising the body’s immune system, increasing susceptibility to gum and bone infections around the teeth. Loose teeth, sores, and pus-filled pockets in the gums are also associated with diabetes.

Increased Appetite

Heightened cravings for sugary foods and increased hunger are additional warning signs of diabetes.

Dry Mouth

Often accompanied by dry, cracked lips and a rough tongue.

Managing Diabetes in the Elderly: Susceptibility & Diagnosis Delays  

Diagnosing diabetes in older adults is frequently postponed due to dementia and urinary incontinence, which can be mistaken for age-related changes.

While age does elevate the risk of Type 2 diabetes, older adults can be more susceptible to the disease due to: 

• Lack of physical activity
• Sleep deprivation
• Metabolic syndrome

Older adults are at a higher risk for complications and are hospitalized more frequently due to low blood sugar. This is attributed to several factors, including diminished sensitivity of pancreatic cells in the elderly and increased insulin resistance with age. 

Typical Diabetes Complications in Older Adults

Hypertension

People with diabetes commonly experience high blood pressure. Older adults with high blood pressure are at a heightened risk of strokes and heart attacks. High blood pressure can also impact vision, kidneys, and circulation.

Depression

Older adults with diabetes face an elevated risk of depression. Managing and controlling diabetes can be challenging, potentially leading to depression. Common signs of depression in older individuals include feelings of sadness, frequent fatigue, loss of interest in previously enjoyed activities, sleep disturbances (either excessive sleep or insomnia), significant weight gain or loss, and difficulty in performing daily tasks.

Falls

Elderly individuals are more susceptible to falls that can result in severe injuries. Having diabetes further increases this risk. Additionally, older adults with diabetes are more likely to take multiple medications, which can further elevate the risk of falls due to medication side effects.

Urinary Incontinence

Diabetes can cause nerve damage in the bladder, leading to loss of bladder control. This nerve damage may signal to the body that the bladder is full, leading to the urge to urinate. Bladder infections are also common in individuals with diabetes and can contribute to urinary incontinence. This condition can also lead to depression, sexual issues, and injuries resulting from rushing to the bathroom.

Cognitive Issues

Older adults with diabetes face a heightened risk of memory impairment. This can impact their decision-making abilities and memory retention.

Medication Usage

Many older adults take prescription medications for myriad health conditions. Caution should be exercised when administering medications to older adults, as while certain medications may be beneficial for one health issue, they could cause adverse effects when combined with other medicines. 

The Bottom Line

Managing diabetes in the elderly presents a multifaceted challenge. Older adults with diabetes are more prone to complications, often presenting with frailty and multiple health conditions. Therefore, it is crucial that the treatment plan for older adults diagnosed with diabetes is tailored to the individual and focuses on the patient’s needs. Prioritizing the prevention of both low and high blood sugar levels is crucial for the health and safety of elderly individuals dealing with diabetes. 

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