Diabetes in older people
Diabetes (also called diabetes mellitus) is a chronic (ongoing) condition characterised by high blood glucose (blood sugar) levels due to the body’s inability to produce or respond to insulin, a hormone that allows blood glucose to enter the cells of the body and be used for energy.
The risk of diabetes (type 2 diabetes) increases with age. In Australia, one in 6 people over 65 years report having diabetes, and nearly a fifth of people aged over 85 years. The most common type of diabetes in older people is type 2 diabetes.
Why are older people more at risk of diabetes?
Major risk factors for diabetes include age, being overweight, and having a family history of diabetes.
The rates of type 2 diabetes steadily increase with age. One of the reasons for this is increasing insulin resistance with age. Factors that contribute to insulin resistance are decreased muscle mass (sarcopenia), overweight and reduced physical activity in older people. In addition, the pancreas does not function as well as in younger people.
Type 2 diabetes is most likely to occur if you:
- are over 45 years old and have high blood pressure;
- are over 45 years old and are overweight;
- have a family history of diabetes;
- are over 55 years of age;
- have or have had high blood sugar levels during pregnancy (a condition called gestational diabetes) or given birth to a baby more than 4.5 kg in weight;
- have polycystic ovary syndrome;
- being overweight or obese;
- have pre-diabetes – blood glucose levels that are slightly raised but not high enough to diagnose diabetes;
- are an Aboriginal Australian or Torres Strait Islander and are over 35 years old (or younger if overweight); or
- are a Pacific Islander, are from a Chinese cultural background or are from the Indian sub-continent and are over 35 years old.
Diabetes is an insidious disease and may develop over many years. For this reason having regular blood sugar tests can help identify whether someone is having problems regulating their blood sugar early on.
Pre-diabetes is the name given to a state when blood glucose concentrations may be higher than normal due to impaired glucose metabolism, but not yet high enough to pass the threshold for a diagnosis of diabetes.
Pre-diabetes does not have any symptoms. More than 2 million Australians may have pre-diabetes, many of them older people. People with pre-diabetes are much more likely to go on to develop type 2 diabetes than other people.
People with pre-diabetes may be able to reverse their situation by losing weight and adopting a healthy lifestyle including more physical activity and a healthy diet. Around two-thirds of people in this group may be able to avoid going on to develop type 2 diabetes.
What are the symptoms of diabetes in older people?
A key issue for older people with diabetes is that, sometimes, the symptoms may not be very obvious. Changes due to ageing may mask the symptoms of diabetes or make them harder to spot. In any case, mild to moderately raised blood sugar levels may not cause symptoms.
The well-known symptoms of diabetes, such as passing more urine and feeling excessively thirsty, are not as obvious in older people as in young people and usually occur when blood sugar levels are quite high.
In addition, other symptoms of type 2 diabetes, such as feeling tired and lethargic, or gradually putting on weight, can often be misinterpreted as just part of the normal ageing process.
As a result, older people with type 2 diabetes may remain undiagnosed until damage has been done.
Complications of undiagnosed type 2 diabetes
If left unchecked, the accumulation of glucose in the blood can cause enormous damage to nearly every major organ in the body, including:
- kidney damage, which may lead to dialysis;
- artery damage (which increases the risk of stroke and heart attack);
- eye damage, leading to vision loss;
- erectile dysfunction (impotence) in men; and
- nerve damage, which can lead to traumatic injury and infection, possibly leading to limb amputation.
It’s unlikely you’ll be able to mend the damage that has already been done, but you and your doctor can work together to control your blood sugar and help minimise the impact of diabetes in the future.
With many Australians now living to the age of 80+ years, preventing long-term complications of diabetes from further damaging your health is vital.
Why are older people more adversely affected by diabetes?
Older Australians are more likely to have other health conditions that impact on their diabetes and make it more difficult to manage. Conditions such as high blood pressure, heart disease and peripheral vascular disease.
Being more frail and susceptible to illness means that older people with diabetes are impacted more by complications, and the complications may be more difficult to manage.
Being less mobile and active may make it harder for older Australians to adopt healthy lifestyle measures to help manage their diabetes. Similarly, other medical conditions such as arthritis may affect an older person’s ability to cook healthy meals or be physically active.
Unfortunately, having diabetes makes older people more likely to experience eyesight damage, kidney disease and be at risk of needing amputation. Older Australians with type 2 diabetes are more likely to require help with living tasks, need hospitalisation, or die.
How do other health conditions affect diabetes?
As mentioned, many older people have other conditions as well as diabetes, and this can complicate management of their diabetes.
For example, high blood pressure or high levels of certain fats in the blood can speed up the progression of common complications of diabetes, such as kidney problems, eye problems, foot problems and heart and blood vessel problems.
People with type 2 diabetes tend to have low levels of HDL (good) cholesterol and raised triglyceride levels. Triglycerides are a type of blood fat. They are the main form of stored fat in your body. Triglycerides are made when you eat food and your body converts any excess energy into triglycerides for use later. High levels of triglycerides are a bad thing, and are associated with increased risk of heart disease, diabetes and fatty liver. They are associated with build up of plaque in your arteries.
In addition, people with type 2 diabetes tend to have changes to the profile of LDL (bad) cholesterol, shown as an increase in large very low-density lipoprotein particles and small dense LDLs, among other things. In people with diabetes, LDL can become bonded with sugar molecules (glycated), which makes it smaller and denser and stickier than normal. This makes it more likely to attach to artery walls, forming fatty plaques.
People with diabetes whose blood glucose levels are high are more prone to infections than people with normal blood glucose levels, so, as well as keeping your blood glucose levels in check, you should also take precautionary measures against additional infection, for example, by having regular vaccinations against ‘flu and pneumonia (pneumococcal vaccination).
Some medications, herbs and supplements can also have an impact on your blood glucose levels, so make sure you tell each doctor, pharmacist and complementary healthcare practitioner who treats you that you have diabetes so they can recommend the appropriate treatment for you.
How can my doctor help me manage my diabetes?
Your doctor can help you to manage your diabetes at any age, but if you are an older person with diabetes, it’s important that you seek their support. Your doctor can:
- organise your diabetes health checks;
- run blood tests regularly to check that your diabetes is under control, including an HbA1c test (blood test that shows an average of your blood glucose over the past 10-12 weeks);
- check your eyes regularly to keep track of possible eye disease (diabetic retinopathy);
- monitor your weight and help you lose weight if you need to;
- measure your blood pressure regularly and provide treatment for high blood pressure, if needed;
- check the health of your feet for any signs of foot ulcers or infections and recommend a specialist or podiatrist to help manage any diabetic foot problems;
- monitor your levels of cholesterol and triglycerides (types of fat found in the bloodstream) regularly, and provide treatment if your levels are outside the normal range;
- conduct regular urine tests to check for any kidney problems (diabetic nephropathy);
- ensure you visit your dentist every 6 months;
- ensure you have your hearing assessed every year;
- keep vaccinations against ‘flu and pneumococcal disease up-to-date to help prevent additional illness;
- prescribe tablets known as oral hypoglycaemic agents (or insulin, if necessary), if adopting a healthier lifestyle hasn’t helped you to control your diabetes;
- refer you for a ‘Home Medicines Review’ (on Medicare), where a pharmacist comes to your home and checks that you are taking your medicines correctly, and that you are using any medical devices correctly; and
- help you prepare a sick day management plan, for when you feel unwell and it’s more difficult to manage your diabetes.
What is the NDSS?
The National Diabetes Services Scheme (NDSS) is an Australian Government initiative to help people with diabetes to manage their condition. Anyone who has been diagnosed with diabetes who holds a Medicare or Veterans’ Affairs card is eligible for the NDSS.
The NDSS can help older Australians living with diabetes to understand the health system and manage their diabetes.
The NDSS has a helpline (1800 637 700) and a website (ndss.com.au). The NDSS is run by Diabetes Australia.
It also allows people to access subsidised products such as testing strips and insulin pens.
What can I do to help manage my condition?
Many different healthcare professionals are involved in the care of people with type 2 diabetes, but you are the most important member of your health care team. You can help get the most out of the health care system by getting involved in your own care and keeping your doctor or other healthcare professional informed of any issues. Let them know if you are having problems and they will try to help you.
Some of the things you can do are:
- work with your doctor and any other healthcare professionals, such as diabetes educators, to learn how to keep control of your diabetes;
- keep in regular contact with your doctor;
- see a podiatrist for regular check-ups;
- wear proper footwear and examine your feet every night to check for problems;
- tell all the health professionals with whom you come in contact that you have diabetes;
- conduct regular blood glucose monitoring to keep track of your condition;
- watch your diet and make healthy choices such as eating less saturated fat and more healthy, complex carbohydrate-containing foods such as fruit, vegetables, brown rice, oatmeal and legumes;
- quit smoking, if you smoke;
- lose weight if you need to;
- do some form of physical activity, under the guidance of your doctor;
- keep any recommended vaccinations up-to-date;
- ensure you take your medication according to your doctor’s instructions;
- tell your doctor if you are having any problems with your sexual health; and
- tell healthcare professionals if you are taking any herbal products, vitamins or over-the-counter remedies.
Remember, while untreated diabetes puts you at significant risk of a range of serious health problems, this risk can be vastly improved by getting diagnosed and getting appropriate medical and lifestyle treatment.