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7/31/2019 003Diabetes in the Elderly_The Best Way to Help Your Diabetic Parent
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Summary: This 1310-word article is aimed at elderly diabetic patients and contains all the
information they need to deal effectively with diabetes. Often the elderly do not have adequate
information or understanding of the diabetes, especially the principles of its treatment and the
way to minimize its complications. If your parent is diabetic, you can provide them with this
information and help them to handle diabetes more effectively. Includes bonus twitter
summary.
Key words: Diabetes, elderly, parent, parents, diabetes mellitus, glucose, treatment,
complications, blood glucose, information, knowledge, diabetic parent, diabetic, hypoglycemia
Diabetes in the Elderly: The Best Way to Help Your Diabetic Parent
By Rohi Shetty
Diabetes is principally a disease of the middle-aged and elderly; more than one in ten people
over 65 suffer from diabetes. Often the elderly do not have access to information about diabetes
and this affects their ability and willingness to follow advice about diet, exercise and
medicines. Doctors often do not have time to counsel them fully. The following information
about diabetes is presented in the question-answer format. If your parents suffer from diabetes,you can ensure they have the knowledge and understanding to deal with diabetes with
confidence and success.
1. What is diabetes?
Diabetes is a condition in which there is increased sugar (glucose) in the bloodstream. This
happens because the pancreas does not produce enough insulin or because the body tissues are
resistant to the action of insulin.
Insulin is responsible for moving glucose from the blood into the body cells especially after
meals. It acts like a key opening a door into the cell for the glucose to enter. So, when there is
no insulin or when the body is resistant to its action, glucose cannot enter the cells andaccumulates in the blood. Increased blood glucose, over time, leads to progressive damage to
blood vessels and nerves.
2. What are the symptoms of diabetes and how are they caused?
Many people with diabetes may not have any symptoms.
Fatigue is often the first symptom. Since glucose is unable to enter the cells, the muscles tire
easily because they do not have the basic fuel they need for power.
Meanwhile, the glucose that cannot get into the cells of the body builds up in the blood. The
kidneys are able to reabsorb all the glucose in the blood until blood glucose level is more than180 mg/dl. Once the glucose in the blood exceeds 180 mg/dl, it passes through the kidneys into
the urine and carries water along with it. So, extra water is lost in the urine resulting in thirst
and increased intake of water. So, fatigue, increased urination and increased thirst are all
symptoms of glucose not being able to get into your cells.
Also, you may lose weight even though you are eating plenty of food because nutrients are
unable to enter your cells.
3. How is diabetes diagnosed?
Normal blood glucose is less than 100 mg/dl after an 8-hour fast and less than 140 mg/dl after a
two-hour glucose tolerance test.)
Diagnosis of diabetes is confirmed if:
blood glucose is 126 mg/dl (7.0 mmol/l) or higher after an 8-hour fast
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blood glucose is 200 mg/dl (mg/dl) or higher, two hours after a meal
blood glucose is 200 mg/dl two hours after drinking 75 grams of glucose
(glucose tolerance test)
Prediabetes (impaired tolerance of glucose) indicating increased risk of developing diabetes in
future is diagnosed if:
blood glucose is between 100 and 126 mg/dl after an 8-hour fast
blood glucose is between 140 to 200 mg/dl two hours after drinking 75 grams ofglucose
4. What are the different types of diabetes?
Type 1 diabetes is caused by a lack of insulin and is usually seen in children.
Type 2 diabetes is mainly because of resistance of body tissues to insulin and
develops in middle-age. Ninety percent of all diabetics worldwide have type 2
diabetes.
Gestational diabetes occurs during pregnancy. Though it disappears after
childbirth, it is a sign of insulin resistance and such women are at greater risk of
becoming diabetic in future.
5. What are the complications of diabetes?
If not controlled, the raised blood sugar level can progressively damage the delicate capillaries
as well as the larger blood vessels and nerves in all tissues.
The most common complications of diabetes are:
Heart disease
Kidney failure
Stroke
Blindness
Foot ulcers and eventual amputation
Decrease in general immunity leading to increased risk of infection
6. What are the principles of treatment of diabetes?
Diabetes usually cannot be cured or reversed.
The principles of treatment are:
Keep blood glucose within normal limits
Prevent long-term complications of diabetes with the help of counseling,
healthy diet, adequate exercise, and appropriate medication
Control associated risk factors such as smoking, obesity, increased blood
pressure, high blood cholesterol, and lack of exercise.
Avoid prolonged physical inactivity because it is an independent risk factor for
heart disease.
7. How should diabetes be monitored?
Blood glucose should be checked as frequently as recommended by the doctor.
Blood glucose may have to be checked more frequently if diet, medications,
exercise routine or health status change.
Hemoglobin A1c indicates how well your blood glucose has been controlled in
the preceding three months. It is a better indicator of control of diabetes than
individual blood glucose levels. Hemoglobin Ac1 values below 6.5 percent cut
the risk of complications.
8. How should the complications of diabetes be monitored?
Examine feet daily for ulcers
Visit your doctor regularly and follow his or her advice
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Monitor the following:
1. Body weight and waistline
2. Blood pressure
3. Blood cholesterol
4. Kidney function (urine protein and serum creatinine)
5. Heart function (EKG, stress test, echocardiography, coronary
angiography)
6. Vision (examination of eyes every 3-4 months)
9. What is the treatment of diabetes?
Diet is the mainstay of treatment of diabetes. In many diabetics, control of diet
and reduction of body weight is the only treatment required. Doctors usually
advise a gradual loss of body weight of about one pound every week. To
achieve this, doctors recommend a diet rich in nutrients and fiber and low in fats
and refined carbohydrates. Diabetics are encouraged to eat more vegetables,
fruits, whole grains, and legumes.
Exercise improves control of diabetes by reducing blood glucose and improving
insulin sensitivity. More importantly, exercise is a natural antidepressant and
improves mental wellbeing and sleep. Medication: If diabetes is not controlled by diet and exercise, your doctor may
have to prescribe anti-diabetic tablets or insulin.
10. What is hypoglycemia?
Hypoglycemia means low glucose level in the blood (below 70 mg/dl) and is usually seen in
diabetics treated with insulin or anti-diabetic tablets such as Glimepiride (Amaryl), Nateglinide
(Starlix), Glipizide (Glucotrol), Repaglinide (Prandin), and Glyburide (Glynase). It is either
caused by exercise, delay in meal or increased dose of anti-diabetic medications. Early signs
include shaking, sweating, hunger, anxiety, weakness, dizziness, rapid heartbeat,
lightheadedness, sleepiness, confusion and difficulty in speaking. The immediate solution is to
take about 2-3 spoonfuls of sugar or 4-6 glucose biscuits. Repeat after 15 minutes if the bloodsugar is still low. Inform your doctor who may reduce your anti-diabetic medication.
Hypoglycemia is more common in the elderly and more dangerous so they must take extra
precautions to deal with it.
Avoid long gaps between meals, especially after exercise or insulin
Always carry sugar or glucose biscuits and ingest at the first signs of
hypoglycemia
Wear an identification bracelet stating you are a diabetic and should be given
sugar if you are unconscious or confused and taken to the nearest doctor.
11. What precautions about medications should be taken?The elderly usually have more than one illness and have to take many medications several
times a day. It is important to help them by labeling all medications clearly. If they are likely to
miss or repeat doses, their medicines must be kept in individual boxes and labeled with the date
and time when they are supposed to take them.
Elderly people with diabetes may be handicapped by insufficient knowledge of how to deal
with their illness. The best way you can help your diabetic parent is to provide him or her with
adequate information about diabetes. This will enable them to gain a better understanding of
how to control diabetes and prevent its complications. It will also help them to be more
responsible for their own health.
References:
1. Haslett Christopher et al, eds. Davidsons Principles and Practice of Medicine. 19th ed.
Oxford: Churchill Livingstone; 2002
2. Barnard Neal, Dr. Neal Barnards Program for Reversing Diabetes. New York: Rodale; 2007
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If your parent has diabetes, give him or her the information they need to deal effectively with it.
Find out how here: