Diabetes in Older Adults—What You Need to Know

Nearly 16 million older adults (65 years of age or older) in the United States live with diabetes mellitus, or diabetes, according to the American Diabetes Association (ADA). For reference, that is about a third of older people in the country. Worse yet, using data from fasting plasma glucose tests, experts estimate that roughly a third of seniors with diabetes do not have a diagnosis.

The high prevalence of diabetes in older adults puts this demographic at increased risk of:

• reduced life expectancy,
• yeast infections (thrush),
• cardiovascular disease (heart disease) and heart failure,
• microvascular problems like peripheral neuropathy (nerve damage) and retinopathy (retina damage that can lead to blindness),
• Sarcopenia (loss of muscle strength) and frailty,
• severe hypoglycemia (low blood sugar),
• hyperglycemia (high blood sugar),
• kidney disease,
• cognitive impairment and cognitive dysfunction,
• diabetic ketoacidosis (DKA, a potentially life-threatening condition where the body overproduces ketones),
• and much more.

Considering the high incidence of diabetes among older adults and how severe its complications are, diagnosis and management of diabetes is crucial for older adults.

Diabetes is an endocrine disorder; that is, it is a disorder of the endocrine system, which regulates the body's hormones, meaning the endocrine system has a direct impact on various systems of the body, including the "brain and nervous system, the growth and function of the reproductive system, as well as the metabolism and blood sugar." Elderly people are not only at greater risk of having diabetes, but also of experiencing more severe complications from this disease than other age groups.

Risk factors and comorbidities for diabetes in older people include:

• Proton pump inhibitor (PPI) use - Older people commonly use proton pump inhibitors (PPIs) long term to manage other conditions. Some research links PPIs with a higher type 2 diabetes risk in older patients.
• Increased body weight - Aging can increase the risk of becoming overweight; obesity is associated with an increased risk of developing type 2 diabetes.
• Sodium-glucose cotransporter-2 (SGLT-2) inhibitor use - Using sodium-glucose cotransporter-2 (SGLT-2s) inhibitors like Jardiance (empagliflozin) may increase the risk of DKA.
• Increased insulin resistance - Research shows that aging can result in increased resistance to insulin in addition to reduced clearance rate of insulin, putting older adults at special risk of diabetes.

Most people associate type 1 diabetes with children, but the truth is that people of any age group can be type 1 diabetic. Type 1 diabetes is an autoimmune condition in which the body—specifically the pancreas—does not make insulin, which regulates blood glucose levels, or blood sugar levels. Without proper treatment, type 1 diabetics (especially elderly patients) are at high risk of hypoglycemia, or severely low blood sugar, which can quickly become a life-threatening condition.

The primary treatment for older people with type 1 diabetes is insulin therapy, which can take the form of:

• Multiple daily injections (MDIs) of insulin
• Insulin pump therapy, or continuous subcutaneous insulin infusion (CSII)
• Insulin pump therapy with continuous glucose monitoring (GCM)
• Premixed insulins (rarely)

In addition to insulin therapy, older type 1 diabetics can benefit from managing other comorbid conditions that put them at greater risk of severe complications, such as cardiovascular problems. Managing cardiovascular risk factors in the elderly can include getting proper exercise and eating a healthy diet to reduce high blood pressure and maintain healthy cholesterol levels.

Type 2 diabetes occurs when the body either produces too little insulin or develops insulin resistance, which can lead to difficulties managing blood sugar levels. For older adults to keep diabetes and its side effects managed, many clinicians recommend a combination of the following:

• Some form of insulin therapy
• Medications like metformin or sulfonylureas
• Healthy diet
• Exercise (both strength training and cardio)
• Proper hydration
• Participation in clinical trials
• Self-care to manage mood and mental health

Prediabetes is when someone has high blood glucose levels—but not high enough to be considered a type 2 diabetic. In other words, when someone has prediabetes, they are at higher risk of developing type 2 diabetes and further complications. People with prediabetes are encouraged to work with a medical team to develop their own diabetes prevention program (DPP) and hit their hemoglobin A1C (HBA1C) and glycemic targets (blood glucose targets) to create a lower risk of developing full-blown diabetes.

This prevention program can include a healthy diet and exercise with a focus on weight loss, lowering cholesterol, and managing blood pressure.

Managing diabetes might seem overwhelming at first, but families should know that they are not alone. For starters, Medicare covers many types of diabetes treatments. Even better, the experts at all senior living communities in the St. Andrew's network are always ready to help.

We know that treatment of diabetes varies depending on the individual and what their unique needs are.

At St. Andrew's, we work with residents, their caregivers, and their families to improve older adults' quality of life and reduce the odds of serious complications of diabetes. To achieve those goals, we assist with diabetes education for patients and loved ones, follow residents' primary care physicians' dietary guidelines, ensure that residents take all necessary medications and supplements, and offer residents the opportunity to engage in regular physical activity.

Your loved one's health and well-being is our priority. Contact us today to learn more about how we can work together to craft a diabetes management plan that works for your aging relative.

Disclaimers: This article is for informational purposes only. It cannot be used to diagnose, treat, prevent, or cure any disease or condition. Always direct any health concerns or questions regarding diabetes in older adults to a licensed healthcare professional.