We conclude our series on living with diabetes across all life’s stages by looking at the last stage – the elderly.
The elderly are adults who are 60 years and older.
The elderly are a peculiar group because ageing causes some natural decline in many body functions. This means that in someone who has diabetes, they must also account for possibly coexisting hypertension, poor kidney health, degrading vision or cognition, proneness to falls, and polypharmacy.
This post will help you draw attention to those specific challenges and how to overcome them.
Impact of Diabetes in the Elderly
About 7% of the elderly in Nigeria have diabetes – that is more than 1 in 20 persons. Your risk of developing diabetes (particularly type 2) increases with age, especially when you have other risk factors like a family history of diabetes, being overweight, or being physically inactive.
Do you remember the complications we discussed in the post on middle-aged adults? Well, the elderly are at increased risk for these complications. They are also more likely to die from diabetes, especially when it is poorly controlled.
Peculiarities of Managing Diabetes in the Elderly
1. Hypoglycemia unawareness
The elderly may not quickly recognize when their blood sugar is low. This can allow blood sugar levels to drop to dangerously low values. When too low, it can lead to falls, fractures, permanent brain damage, and even death.
2. Polypharmacy
Polypharmacy is the practice of using five or more routine medications for treating chronic diseases. Elderly people who have diabetes are very likely to be using multiple medications to treat other diseases like hypertension, high cholesterol, and arthritis.
The problems with polypharmacy are many. I’ll mention two. First, it is exhausting and makes it harder for patients to comply with their treatment regimen. Second, the drugs can cross-react, reduce one another’s effectiveness, or create new side effects.
3. Impaired memory or intellect
Some elderly people have difficulty remembering scheduled medications, doctor’s appointments, or proper diet and exercise routines.
4. Reduced appetite
Also known as “anorexia of ageing.” Many elderly people generally have a poor appetite. But if you are using insulin or certain antidiabetic pills that can cause low blood sugar, your meals must be well planned and regular, or you may develop hypoglycemia.
5. Muscle weakness
Muscle mass and strength generally weaken with increasing age. This limits how vigorous your physical activity can be and increases the risk of falls and wounds.
6. Other coexisting diseases
Elderly people often have one or more chronic diseases coexisting with diabetes. These include hypertension, cataracts, past strokes, chronic kidney disease, among others. These conditions and diabetes are mutually reinforcing and accelerate damage to the organs affected.
Practical Tips for the Elderly Living with Diabetes
Consistently monitor your blood sugar on waking, before meals, or at bedtime. Remember that more than 60% of silent hypoglycaemic episodes occur at night.
Use continuous glucose monitoring (CGM) if you can afford it. It is more convenient and sensitive than finger-prick glucometers and helps detect silent hypoglycemia.
Learn to recognize the signs of hypoglycaemia such as sweating, hunger, fatigue, jitteriness, and poor concentration. If these symptoms occur, check your blood sugar immediately. If it is low, take a sugar-rich drink and eat a meal afterward.
Do not use insulin without following it with a meal.
Have a responsible and intelligent caregiver to help you keep track of medications, appointments, and meals.
Use a pill box to help with the timed use of medications. Alarms and digital calendars can also serve as useful reminders.
When possible, use fixed-dose combination drugs, which combine two or more antidiabetic medications into one pill. This improves medication compliance and reduces fatigue and confusion.
Do not miss clinic appointments. These visits allow your doctor to review your medications and adjust or remove them when necessary.
Instead of eating three large meals a day, eat small, frequent, nutrient-dense meals so your appetite is not overwhelmed.
Engage in muscle-strengthening exercises. Always consult your doctor or physiotherapist about the level of exercise you can safely tolerate.
As you take care of diabetes, do not forget the other conditions you may have. They may be many diseases, but yours is one body.
Diabetes is a complex disease that can span the entire lifespan of a human being. But with patience, knowledge, and determination, you can address its every facet and meet it at each point, so you always have the upper hand—no matter how old or young you are.
