The Diabetes of Older Adults
George had just turned 70 when he began feeling thirsty, hungry, and tired more often than usual. After several weeks, he noticed that things seemed to look a bit blurry, his skin felt dry and itchy, and his feet felt tingly. At first he thought these were just signs of aging, but after another few weeks of feeling under the weather, he decided to see his doctor. Blood tests showed that he had type 2 diabetes. In addition, his eye doctor found evidence of some vision loss.
What Is Type 2 Diabetes?
Diabetes is a disorder caused by your body's inability to properly use and store glucose—a form of sugar that is the body's main source of energy. This condition can cause a wide range of health problems.
There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes (juvenile onset) usually develops in children and young adults, but may occur at any age. Gestational diabetes occurs during pregnancy.
This article will focus on type 2 diabetes (formerly called non-insulin-dependent diabetes) because it is the most common form of diabetes. It typically occurs in people over age 40, is most common in those over 55, and overall, is a condition found in 15 million Americans.
Type 2 diabetes tends to run in families, and additional factors contribute to its onset; the most common is being overweight. In addition, African Americans, Asians, people of Hispanic descent, and Native Americans have increased risk of developing diabetes.
Food and Diabetes
After eating, your body converts almost all of the carbohydrates (sugar) and some of the protein from the foods you've eaten into glucose. Glucose is the preferred energy source for all the cells of the body. Your bloodstream carries the glucose to your cells, but it is not able to enter the cells unless insulin is present. Insulin is the key that lets glucose into the cells. Otherwise, the glucose just sits in the bloodstream, outside the cells.
Insulin is a hormone made by the pancreas, a large gland behind the stomach. People with type 2 diabetes do not respond to insulin properly. As a result, glucose cannot enter the cells, is unavailable as fuel for your body, and builds up in the blood. Because the blood can only hold a limited amount of glucose, some of the glucose is excreted in urine.
Symptoms Sneak Up on You
The symptoms of type 2 diabetes usually develop gradually, and can be so mild that people don't notice them or mistake them for signs of aging. In fact, a third of all Americans with diabetes don't know they have it.
The buildup of glucose in the bloodstream triggers some of the more noticeable symptoms, such as:
- Increased thirst
- Increased urination
- Increased hunger
- Increased weight loss (without trying)
- Increased fatigue
- Blurry vision
- Sores that heal slowly
- Dry, itchy skin
- Tingling or loss of feeling in the feet
- Frequent skin, bladder, or gum infections
When a person has untreated diabetes, glucose is unable to enter the cells so that it can be used as energy. The cells start to break down fat and protein for energy, which causes weight loss and leaves less protein available for healing functions. The excessive glucose in the urine causes more sodium to be drawn out of the body, which causes increased thirst.
Complications of Diabetes
If the level of sugar in your blood is much too high or too low, you can become quite sick. Poorly controlled diabetes can also lead to long-term, irreversible health problems. Many of these problems go unnoticed until they've become serious.
Diabetes is first diagnosed by tests that measure the amount of glucose and/or other metabolic compounds in the blood. The most common test is the fasting glucose test, in which the blood sugar level is measured in the morning before eating and at least 8-12 hours after the last meal.
An oral glucose tolerance test may also be done in certain situations. Urine tests cannot detect the early stages of diabetes, and are therefore not used for diagnosis (though diabetes is sometimes discovered accidentally by means of a urine test performed for other purposes).
Managing Your Illness
Because diabetes is a lifetime disorder, treatment focuses on managing the disease. The goal is to keep your blood sugar level within a normal range and avoid complications. In some people, losing weight is a cure for type 2 diabetes. For others, weight loss, exercise, and careful attention to diet can keep diabetes under control. Many people, especially those unable to make adequate lifestyle changes, need to take diabetes pills. A relatively small percentage need insulin injections.
Monitoring Blood Sugar
Growing evidence shows that tighter control of blood sugar levels can lower your risk of heart disease and possibly other long-term complications. Most likely you will need to monitor your blood sugar levels at home, using blood you take from a finger prick and analyzing it in a hand-held machine. For those who are squeamish about drawing their own blood, a new device may soon be available that continuously measures blood sugar with a small sensor implanted under the skin.
If diet, exercise, and weight loss don't keep your blood sugar at safe levels, you may need to use medication to get things under control. Several types of oral medicines are used (including sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors), as well as injections of insulin. An insulin pump may also be used in certain instances.
New medications are under development that are more effective with fewer side effects, and researchers are working on new ways to give insulin, including a nasal spray, an inhaler, pills, and a patch.
People with diabetes can eat sugar, so long as they stick to a meal plan that is balanced for their individual needs. However, there are some foods that diabetics are encouraged to eat because they might keep blood glucose at a more constant level.
These foods include whole grain, fiber-rich products such as whole grain breads, pasta, and cereals. Other foods rich in fiber, vitamins, and minerals that are good for people with diabetes include colorful vegetables like red peppers, tomatoes, carrots, spinach, and yellow squash because they contain vitamins that help preserve vision and may reduce the risk of heart disease and cancer.
People at risk for type 2 diabetes can delay or entirely prevent the disease and its complications by maintaining a healthy weight, exercising regularly, and eating a healthful diet.
"Getting diagnosed and treated early is also very important in preventing and delaying complications of diabetes," according to Kenneth Snow, MD, medical director at the Joslin-Lahey Center for Diabetes and Endocrinology in Peabody, MA. "Over a quarter of all people with type 2 diabetes already have at least one complication when they are diagnosed. However, almost all complications can be either delayed or prevented with appropriate treatment."
The American Diabetes Association recommends that everyone age 45 and older have their blood sugar tested every three years, and more often if they are at high risk for diabetes.
A Success Story
As for George, after a few months of faithfully following his exercise and meal plans, he is feeling much better and is back to his usual activities. Although he did have some permanent vision loss, this problem has now stabilized. He encouraged his 45-year-old daughter to have her blood sugar tested. She found that she, too, has high blood sugar, so she has started exercise and meal plans to avoid developing any symptoms or complications.
If you think you may have or be at risk for diabetes, talk with your doctor about getting diagnosed and treated. Most people with diabetes who follow their treatment plan can live healthy, fulfilling lives.
American Diabetes Association (ADA)
Joslin Diabetes Center
National Diabetes Information Clearinghouse (NDIC)
Canadian Diabetes Association
Cefalu WT. Glycemic control and cardiovascular disease--should we reassess clinical goals?. N Engl J Med. 2005;353:2707-2709.
Diabetes risk test American Diabetes Association website. Available at: http://www.diabetes.org/main/info/risk/risktest.jsp.
Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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