Navigating Diabetes With Increasing Age

Introduction

Living with diabetes might be challenging, especially as you grow older. According to estimates, diabetes affects around 33% of those aged 65 years and older. Older adults with diabetes may face higher risks for various acute and chronic complications, such as vision problems and heart attack. However, by approaching diabetes with vigilance and proper care, it is possible to effectively alleviate these risks and live a fulfilling life. Let us explore how age and diabetes intertwine and discover a few strategies that may help us overcome these challenges while embracing the opportunities that lie ahead.

Making Informed Food Choices

Dietary guidelines for older adults with diabetes may be different from general recommendations. Factors such as medication side-effects, limitation in mobility, poor oral health, and impaired vision might cause uneasiness related to eating in the elderly population. Consequently, older adults with diabetes may experience the following difficulties:

• Irregular or poor eating habits may contribute to episodes of low blood sugar (hypoglycaemia).
• Older adults are often unable to monitor their fluid intake, which may lead to dehydration, especially during extremely hot weather and illness.
• In care homes, older adults tend to have a higher likelihood of being underweight rather than overweight, indicating undernutrition might be a common feature in this group of population.

Therefore, the following guidance on dietary modification may be useful for managing diabetes in older adults:

• It may not always be necessary to reduce salt, fat, and sugar intake for every older adult with diabetes.
• Nutritional assessments and personalised advice from dieticians are important for individuals at risk, addressing specific concerns like increased calorie needs, low-salt diet, meal supplements, manageable food options and weight management.
• To avoid sharp spikes in blood sugar levels without overly restricting the diet, it is advisable to limit large carbohydrate intake in one meal; instead, you can divide it between all meals of the day.
• Care plans in old-age homes should include nutritional assessments and dietary considerations. Personal food preferences are important, and older adults with diabetes should be able to enjoy a range of food items.

Embracing Exercise

It may be beneficial for older adults to think about making lifestyle changes, including incorporating exercise into their routine.

Moreover, staying active in old age has several benefits, including preserving mobility and balance, strengthening muscles and when it comes to diabetes, it can help in improving sensitivity to insulin. It may also improve your mental well-being and reduce the risk of falls.

The following precautions will enable you make a better plan for staying active and allow you to adhere to it for the long term:

• When creating an exercise plan, it is crucial to consider the physical ability of the patients.
• For instance, older adults who are particularly not active and may be at a risk of falls may start by walking inside their house for 5-10 minutes, two to three times a day.
• The exercise duration may be gradually increased as they adapt to it.

Managing Hypoglycaemia

Older people with diabetes may have a higher risk of experiencing hypoglycaemia due to factors like substandard food intake, certain diabetic medications, kidney problems, and other illnesses. They may have subtle or no warning signs and caregivers may notice signs like difficulty concentrating, personality changes, headache after waking up and disturbances in sleep. If hypoglycaemia goes unnoticed, it may lead to severe complications. It is recommended to consult with your doctor for controlling hypoglycaemia. However, the following suggestions may be beneficial for you:

• If someone is conscious and experiencing hypoglycaemia, it is important to handle it right away. Give them a sugary drink or glucose tablets, and then give them something starchy like biscuits. Call for medical assistance or an ambulance if someone is unconscious.
• To avoid hypoglycaemia, it is important to have regular meals and snacks that include a healthy amount of carbohydrates.
• When managing blood sugar levels, it is important to set target levels that are not excessively strict and ensure that the prescribed medication is suitable for everyone.
• Regular blood glucose monitoring in older adults might help identify those who may be at risk of low blood sugar, but it should always be considered alongside long-term blood test results, such as HbA1c, to get a comprehensive understanding of the situation.

Bonus Tips

• Older adults need to consider reducing alcohol intake and abstaining from smoking.
• Anything that affects the mental health might also have an impact on how well diabetes is managed. Identifying and addressing these issues early on may help minimise their long‑term effects.
• Collaborative care by the treating physician, diabetes educator, endocrinologist, geriatrician, nutritionist, and social worker is crucial for older adults with complex healthcare requirements and those who take multiple medications (polypharmacy). It may be productive to consider monitoring potential interactions between medications and encouraging necessary support from family and community.
• Reduction in physical abilities with age may negatively impact self-care. Eye conditions, reduced foot care, and urinary incontinence might be linked to ageing and diabetes. It is, therefore, essential to keep an eye out for any changes in medication needs and not hesitate to seek help and support for new symptoms or difficulties faced in self-care.

Conclusion

Older adults with diabetes should receive comprehensive care that addresses their unique needs. This includes considering dietary modifications, lifestyle changes, monitoring blood sugar levels, managing medications, and addressing associated health issues. By promoting collaborative care between healthcare providers and providing support, we can empower older adults to effectively manage their diabetes and improve their overall well-being.