Treating diabetes can be a whole new ballgame for those over 70 due to the many factors that accompany the aging process. Many older adults with diabetes have additional medical conditions that require concurrent treatment, and they may be on multiple drugs that have conflicting or additive side effects.
The International Association of Gerontology and Geriatrics, the European Diabetes Working Party for Older People, and the International Task Force of Experts in Diabetes combined resources to tackle the problem of addressing the needs of older adults with diabetes.
The physical changes that can be associated with aging, such as reduced eye sight and hearing, and loss of physical stability can pose barriers to the successful completion of self-care behaviors. For example, fading vision can make it difficult to see the markings on insulin syringes and dose medication accurately. Loss of muscle mass and balance can predispose older adults to the risk of falls from hypoglycemia.
Cognitive impairments, whether full-fledged dementia or subtle changes in memory, judgment and planning skills, can render the complex requirements of self-management of a multiple daily dose insulin regimen not only overwhelming but often dangerous.
In addition, loss of family and social contacts which can exacerbate already existing mood disorders may cause older adults to abandon usual routines of healthy eating and physical activity leading to poor glycolic control.
In their position paper published in the July 2012 edition of Journal of the American Medical Directors Association, the group addressed eight categories of concern: hypoglycemia, therapy, diabetes in the nursing home, influence of co morbidities, glucose targets, family/caretaker perspectives, diabetes education, and patient safety.
Hypoglycemia is often one of the most dangerous acute side effects of diabetes in this age group. The panel emphasized the importance of avoiding hypoglycemia in this group by discontinuing or avoiding Sulfonylurea therapy (drugs that cause the pancreas to secrete insulin–the delivery of insulin from the pancreas is not precisely timed and can easily lead to hypoglycemic events in those people who do not eat on a regular schedule or whose appetite waxes and wanes.)
In addition, they recommended:
– All geriatric patients receive a comprehensive assessment that includes physical, cognitive and psychosocial parameters,
– A1C targets in general should be between 7.0mg/dl and 7.5 mg/dl – but should be individualized for co-morbidities, cognitive and functional status.
– Fasting glucose levels for patients taking diabetes medications should be above 108mg/dl.
– Nutrition restrictions should be liberalized for those over 70 or who are undernourished
– Patients should receive instruction in resistance training, balance exercises, and cardiovascular fitness training.
Talk to your health care provider about these new guidelines, and how they fit into your diabetes care.
In addition to the medical establishment loosening their guidelines for acceptable control in the elderly, you can do things for yourself that can make your diabetes self-management easier.
If memory is an issue
- Use your meter to set alarms to remind you to take your medicine or check your blood glucose.
- Get a pill dispenser—if you take a lot of pills this can help you keep track of which medications you need to take and which you have already taken.
If vision is a problem
- Have a bright task light available—you will see better with direct lighting for reading such things as drug labels
- Contrast helps! Put light objects against a dark background and vice-versa to make them stand out.
- Ask your educator about syringe magnifiers that can help you see the markings on the insulin vial
- Ask your educator for a meter that talks or has large print.
If dexterity is an issue
- Ask your educator about meters and supplies that are easy to handle.
And click here to learn more about the Geriatric Clinic at Joslin.