Introduction to Manage Diabetes
Diabetes mellitus can affect people from juveniles to elderly stage. It is an important health condition for the aging population and technically called geriatric diabetes. According to a study, about one-third of older adults have prediabetes, and this proportion might rise rapidly in the coming decades. Although the impact of diabetes is mostly counted with reference to working-age adults, yet diabetes in the elderly is counted in terms of higher rate of mortality and reduced functional status.
Older diabetics are at greater risk of premature death; other illnesses, such as hypertension, cardiac diseases, and stroke, are also seen more in them than those without diabetes. The chances of developing diabetes increases with age. Therefore, older adults with diabetes have it diagnosed after age 65 years, or have long-standing diabetes with onset in middle age or earlier. Let’s find out how to manage diabetes after 50.
Challenges in Managing Geriatric Diabetes
Adults above 50 years may have various medical comorbidities, erratic food intake, functional impairments, and insufficient social support. Individuals with old-age-related syndromes (i.e., chronic pain, urinary incontinence, cognitive dysfunction, frequent falls, and depression) have additional difficulties in performing self-management of their health and thus, have lower quality of life. Clinical, functional, and psychosocial factors that should be identified and addressed when developing treatment plans.
Blood Glucose Management in Diabetes
Older adults with few coexisting chronic illnesses are supposed to have lower glycemic goals (A1C, 7.5%),while those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence have lenient glycemic goals (A1C ,8.0–8.5%). To reduce the risk of hypoglycaemia in the older people, medication classes with low risk of hypoglycemia are preferred. Overtreatment of diabetes is generally avoided. Simplified healthcare regimens are recommended to reduce the risk of hypoglycemia, if possible to achieve.
Glycemic goals might reasonably be relaxed depending upon the individual, but hyperglycemic conditions leading to grave symptoms or any associated risk should be avoided. Individualised screening for diabetic complications should be emphasized. Attention must be given to complications resulting in functional impairment. Hypertension and cardiovascular risk factors must be taken care of. Lipid-lowering therapy and aspirin therapy may work well.
Vision and Hearing Problem Management in Diabetes
Visual and auditory impairments affect the ability to perform self-care tasks for the elderly diabetics. Acute reversible changes in vision and blurred vision can result from serious hypoglycemia or hyperglycemia. This may be a barrier to accurate insulin administration.
Hearing loss may cause failure in fully understanding the instructions from health care providers. Impairment in hearing and sight can reduce social interaction which arises from psychosocial effects (e.g., isolation, fatigue, avoidance). Magnifiers, “talking” glucose measuring devices and instructions typed in large font-size alphabets can be helpful. The impairments in vision and hearing should be addressed during diabetes education and training, and diabetes management plans should be chalked out accordingly.
Fractures and Chronic Pain Management in Diabetes
Chronic pain makes self-care in older diabetic adults difficult, and adds to their glycemic variability. Medication for pain relief can also reduce coordination of body. Additionally, chronic pain leads to increased falls and fractures, depression, decreased rehabilitation process, minimised socialization and high health care costs. Pain in older patients must be assessed at every medical visit and given adequate treatment.
Fall risk should be assessed periodically in older adults. Neuropathy, loss of vision, and balance problems are all risk factors causing falls and subsequent fractures. Older diabetic women are at high risk of hip fractures, which are often fatal. Balance improvement exercises should be encouraged, and walking aids should be used wherever needed. Include daily calcium intake of 1,000–1,200 mg (diet plus supplements), and vitamin D intake of 800–1,000 IU. Additional vitamin D supplements may be prescribed when deficiency is diagnosed.
Cognitive Defect Management in Diabetes
When it is found that there is some cognitive impairment in a diabetic patient, screening for thyroid dysfunction, alcohol use, and vitamin B12 deficiency. performed. Although older diabetics do not present typical symptoms of hypothyroidism the risk of autoimmune thyroid disease in type 1 diabetes exists. Identification of cognitive defects, cooperation from family members or caretakers, simple treatment regimens, and certain cognitive aids can be helpful in such cases.
Physical Inactivity Management in Diabetes
Physical activity is also enlisted in ADA’s diabetes management program. Light-intensity physical activity reportedly shows improvements in physical health, psychological and social well-being. Such exercises, improve the balance and overall functional status of aged people. Home- and community-based exercise programs, taken up. Pre-meal insulin dosing, done properly, or a carbohydrate snack before exercise, help avoid hypoglycemia during or after, increased physical activity. Basal insulin dosing, reduced with regular physical activity.
Elderly people with chronic type 1 diabetes have acute and chronic complications, along with stress. Effective social support can help to have good glycemic control, and good quality of life. Diabetes-related education, frequent consultation with the diabetes care team, transportation assistance, and other social services can help reduce this diabetes-related distress.
It is very important to avoid hypoglycemia. Insulin regimens have to be simplified. Physical activity for maintaining functionality, and regular blood glucose screening, done, in addition, they should be, reminded about continuing basal insulin during inter-current illness or during periods of poor oral intake. Hence, monitor hydration and electrolyte status and abnormalities in case of serious hyperglycemia. Diabetes education, follow-up, and training should be periodically, assessed and conducted along with the family members and caretakers. Take care of your diabetes and follow the intervention as advised by your doctor.