Why is diabetes more common in the elderly?

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    Why is diabetes so important?

    As the years advance, diabetes is increasingly becoming a prevalent issue among the older generation.

    Fully comprehending the dangers and indications of diabetes in elderly adults is crucial to helping them control and avoid any issues that may arise. Yet, it can result in harsh effects and is frequently challenging to identify.

    Delve into the intricacies of diabetes in older generations and uncover the importance of knowing this medical condition that affects many.

    Signs and symptoms of diabetes in elderly adults

    What is diabetes?

    If you’re an elderly individual, learn more about diabetes and the measures you can take to keep it under control.

    Suffering from diabetes is like carrying a heavy burden, as it is a long-term condition that impairs your body’s ability to regulate its glucose or blood sugar levels.
    When the body does not produce enough insulin to turn glucose into energy or properly use insulin, type 2 diabetes develops.

    Managing blood sugar levels through diet and exercise alone is enough for some. In contrast, others may require diabetes medications or insulin injections. In the long run, individuals with diabetes may need to modify their lifestyle and incorporate medicine to manage their condition successfully.

    Diabetes

     

    Why is diabetes more common in the elderly?

    The rates of type 2 diabetes steadily increase with age due to a combination of factors, including increased insulin resistance, impaired pancreatic islet function, decreased muscle mass (sarcopenia), overweight, reduced physical activity, and concomitant chronic diseases.

    In the UK, Public Health England’s data from 2021 reveals that a staggering 3.8 million elderly individuals – or 15% of all people aged 65 or over – are living with diabetes.

    In the white European population, the incidence of Type 2 Diabetes ranges from an average of 2% to as high as 10% among those aged 70 and over. It is significantly more prevalent in the UK among ethnic minorities, mainly South Asian and African-Caribbean groups residing in developed countries.

    Time and time again, research has revealed that with a combination of changes to one’s lifestyle, an individual can reduce their risk of Type 2 Diabetes by an astounding 50%!

    The North West of England boasts the highest prevalence of diabetes among the older groups, with around 19% of those aged 65+ suffering from the condition; conversely, the South East records the lowest majority at a still-significant 12%.

    By the year 2035, an estimated 5.5 million people in the UK are projected to suffer from diabetes, which is a significant factor in blindness, kidney failure, amputations, and cardiovascular disease – a devastating total of over 26,300 fatalities occurring annually in the UK amongst those aged between 20-79.

    Ensuring older adults with diabetes get the correct care, treatment, and support needed to control their condition is essential for improving their quality of life, decreasing their likelihood of suffering complications, and lessening the financial burden on the healthcare system.

    Prediabetes

     

    What is prediabetes?

    Prediabetes is when blood sugar levels are higher than average but not high enough to be classified as type 2 diabetes. Understanding prediabetes is essential because it can increase the risk of developing type 2 diabetes and other health conditions such as heart disease and stroke.

    People with prediabetes have a higher chance of developing type 2 diabetes if they do not make lifestyle changes or take medication to reduce their blood sugar levels. Prediabetes is typically diagnosed with a fasting plasma glucose test, which measures your blood sugar levels after an overnight fast.

    If the results of this test show that your blood sugar levels are higher than average but not high enough to be classified as type 2 diabetes, you may have prediabetes.
    In addition to the fasting plasma glucose test, your doctor may also use an oral glucose tolerance test to diagnose prediabetes. This test measures your blood sugar levels after drinking a sweet liquid. If your blood sugar levels are higher than usual but not high enough to be classified as type 2 diabetes, you may have prediabetes.

    Understanding prediabetes is essential, especially for elderly individuals. Prediabetes increases the risk of developing type 2 diabetes, which can lead to other serious health complications. If you are at risk of prediabetes, it is essential to make lifestyle changes to reduce your risk of developing type 2 diabetes, including eating a healthy diet, exercising regularly, and maintaining a healthy weight.

    Whats the difference between type-1 and type-2 diabetes

     

    What is type 1 and type 2 diabetes?

    Type 1 and Type 2 diabetes are the two different types of diabetes that affect older individuals.

    Type 1 diabetes is an autoimmune disease in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin. It usually develops in childhood or young adulthood and requires daily insulin injections to survive.

    Type 2 diabetes, on the other hand, is a chronic condition in which the body does not use insulin properly. It usually develops in adulthood and is much more common than type 1 diabetes. With type 2 diabetes, the body either does not produce enough insulin or the cells do not respond to the insulin produced. This type of diabetes can often be managed with lifestyle changes such as eating a healthy diet and exercising regularly.

    Understanding the differences between type 1 and type 2 diabetes in the elderly can help doctors diagnose and treat them appropriately. Both types of diabetes can cause serious health complications, so staying informed and taking steps to prevent or manage them is essential.

    Type 1 diabetes

     

    Symptoms of type 1 diabetes

    Symptoms of type 1 diabetes in older generations can often go unnoticed as they are easily mistaken for signs of ageing. Common symptoms include feeling tired, increased hunger or thirst, losing weight without trying, urinating often, or having blurred vision. It’s important to talk to your doctor if you experience any of these symptoms, as they can be signs of a severe problem.

    Type 1 diabetes develops differently in adults than it does in children. At diagnosis, children usually experience a rapid drop in insulin-producing cells that causes their blood sugar to spike. At the same time, adults can produce more insulin and lose it more slowly.

    New technology, such as insulin pumps and glucose sensors, can make management more accessible. However, symptoms can range from mild to severe if not detected early.

    Detecting diabetes in the elderly early can help prevent severe complications. So if you or someone you know is experiencing any of the symptoms of diabetes, it’s essential to talk to your doctor about it. With the proper treatment and lifestyle changes, you can keep your diabetes under control and live a long, healthy life.

    Treating type 1 diabetes

    Treating type 1 diabetes in the elderly is a complex process that requires a comprehensive and integrated team approach. A collaborative and individualised treatment plan is recommended for older adults with type 1 diabetes to establish adequate glycemic control and minimise the risk of acute complications such as hypoglycemia and severe hyperglycemia.


    According to the International Diabetes Federation (IDF), the recommended A1C goal for functionally independent older adults is 7-7.5%, whereas for functionally dependent, frail patients or those with dementia, an A1C goal of 7-8% is recommended.
    Recent studies have revealed that type 1 diabetes can drastically reduce life expectancy by up to 13 years. Therefore, it is essential to pay attention to potential barriers to managing type 1 diabetes in the elderly.


    Fortunately, technology has advanced significantly in recent years. Patients are now using insulin pumps and glucose sensors that can send glucose levels and alerts directly to their smartphones, making it much easier to manage their diabetes.


    Premixed insulins should rarely be used when choosing a treatment plan due to their non-physiological profiles. When other regimens are impossible, twice-daily dosing (before breakfast and dinner) with snacks should be considered to avoid hypoglycemia.
    Furthermore, frequent communication with the diabetes care team and community resources is recommended.


    Physical activity should also be encouraged to help maintain functionality, and regular screenings for barriers to adequate management should be carried out with appropriate intervention.


    Comprehensive geriatric assessments should be conducted periodically to identify functional, cognitive, and psychosocial decline. With the proper care and management, older adults with type 1 diabetes can enjoy a better quality of life.

    Type 2 diabetes

     

    Symptoms of type 2 diabetes

    Type 2 diabetes is a severe health concern for the elderly. It can lead to long-term complications if not managed properly. Symptoms of type 2 diabetes include frequent urination, excessive thirst, fatigue, blurred vision, and slow wound healing.

    Frequent urination, accompanied by excessive thirst, is one of the first signs of type 2 diabetes in the elderly. When the body does not have enough insulin, it cannot properly process glucose, leading to an increased need to urinate. This can cause dehydration, which can lead to further problems.

    Fatigue is another symptom of type 2 diabetes in the elderly. Because the body cannot use glucose for energy effectively, older people may feel tired more frequently than usual.

    Blurred vision is another common symptom of type 2 diabetes. High blood sugar levels can cause fluid to build up in the eyes’ lenses, resulting in blurry vision.

    Finally, slow wound healing is also a sign of type 2 diabetes in the elderly. Without enough insulin, the body cannot effectively heal itself, leading to slow wound healing. This can be a severe issue for the elderly, increasing the risk of infection.

    It is essential to be aware of the symptoms of type 2 diabetes in the elderly, as early diagnosis and treatment can help to prevent long-term complications. Suppose you notice any of these symptoms in yourself or an elderly relative. In that case, seeking medical advice as soon as possible is essential.

    Treating type 2 diabetes

    When treating type 2 diabetes in older adults, lifestyle modifications are the initial recommendation for optimising metabolic control and preventing complications. This includes counselling on nutrition, physical activity, and healthy habits.

    Oral anti-hyperglycemic drugs such as Metformin are also recommended. They are generally considered the first-line medication for type 2 diabetes. Metformin works by decreasing the amount of glucose absorbed from food and reducing the amount of glucose made by the liver. Additionally, it can help the body use insulin more effectively.

    Other medications that may be prescribed to elderly patients with type 2 diabetes include dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose cotransporter (SGLT-2) inhibitors.

    DPP-4 inhibitors work by increasing the number of hormones that help to reduce blood sugar levels.

    GLP-1 receptor agonists lower blood sugar by reducing the amount of glucose the liver makes and increasing insulin production.

    SGLT-2 inhibitors, on the other hand, act by blocking the kidneys’ reabsorption of glucose, leading to increased glucose excretion in the urine.

    The International Diabetes Federation (IDF) recommends different HbA1c targets for functionally independent and dependent older adults. An A1C goal of 7–7.5% is suggested for functionally independent patients, while for functionally dependent, frail patients or those with dementia, an A1C goal of 7–8% is advised.

    In summary, when treating type 2 diabetes in the elderly, lifestyle modification, along with pharmacological interventions, should be employed to achieve optimal glycaemic control. Healthcare professionals should carefully tailor treatment to each individual based on their medical history and comorbidities.

    Diabetes blood tests

     

    Tests for diabetes

    Diagnosing diabetes in the elderly is essential because it can help to prevent severe and life-threatening complications. Three main tests should be used to detect diabetes.

    The first test is a fasting blood glucose test. This test measures the amount of glucose in your blood after you have not had anything to eat or drink for eight hours. If the blood glucose level is higher than usual, this could indicate diabetes.

    The second test is a random blood glucose test. This test considers all of the meals you have had throughout the day and is used to measure glucose levels in the blood. A high reading could indicate diabetes.

    The third and final test for diabetes is an HbA1C test. This test measures the amount of glucose in red blood cells. If the result is higher than average, diabetes is likely to present.

    It is essential to speak with a doctor to determine which test is most appropriate for the elderly. All three tests need to be done to get an accurate diagnosis of diabetes. With the correct diagnosis and treatment plan, diabetes in the elderly can be managed and potentially prevented.

    Diabetes brain health

    Diabetes and brain health

    Diabetes and brain health can severely impact older adults’ cognitive abilities, from mild cognitive impairment to dementia. Studies have indicated that those with diabetes are more likely to experience mental issues such as dementia, Alzheimer’s, and vascular dementia than those without diabetes.

    This is due to diabetes damaging nerves and blood vessels in the brain and, over time, leading to more severe problems like Alzheimer’s.

    The evidence suggests we should consider the brain an end-organ when assessing diabetes complications and recognise the potential for central diabetic encephalopathy or neuropathy.

    Diabetes has been linked to various brain structure and function issues, including memory and learning problems, mood changes, weight gain, and hormonal changes. It is estimated that diabetes accounts for 6-8% of all cases of dementia in elderly adults.

    Mild cognitive impairment (MCI) is also a concern. It could be seen as a pre-dementia state that could indicate someone is at risk of developing dementia. Clinicians must consider cognitive evaluation as part of the end-organ diabetes complication review for their elderly patients.

    This review summarises the evidence for changes in brain function and structure in type 2 diabetes mellitus.

    Be prepared for diabetes

     

    Be prepared

    It’s never too late to start taking steps towards a healthier lifestyle. For those who are elderly and have diabetes, some simple steps can be taken to keep the illness under control. Here are some tips to help older adults with diabetes:

    • Lose extra weight. Losing weight can reduce the risk of developing diabetes. If a person is overweight or obese, even small amounts of weight loss can help to improve blood sugar levels.
    • Be more physically active. Regular physical activity can help to lower blood sugar levels, improve the body’s sensitivity to insulin, and promote weight loss.
    • Eat healthy plant foods. Various fruits, vegetables, and whole grains provide essential nutrients that can help lower blood sugar levels.
    • Eat healthy fats. Fats are an essential part of a healthy diet. Healthy fats, such as those found in olive oil, avocados, and nuts, can help to keep blood sugar levels stable.
    • Skip fad diets and make healthier choices. Fad diets can be risky for people with diabetes, as they can lead to rapid and unhealthy weight loss. Instead, focus on making healthy food choices and exercising regularly.

    Finally, Metformin is an attractive medication for older adults due to its low risk of hypoglycemia. Healthy older adults should be treated similarly to younger adults by initiating Metformin at the time of diabetes diagnosis.

    By taking these steps, older adults with diabetes can be better prepared to manage their illnesses and maintain a healthy lifestyle.

    Conclusion

    In conclusion, diabetes is a severe disease that can cause health problems for elderly individuals if not managed correctly.

    Recognising the warning signs, reducing risk factors, and making lifestyle changes if necessary are essential. Regular checkups and proper medication are vital to keeping blood sugar levels in check and reducing the risk of health problems associated with diabetes.

    With appropriate care and support, elderly individuals can still enjoy a healthy and long life.

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