An estimated 33% of the elderly in the United States live with diabetes. Besides, older adults often have additional health issues such as cognitive impairment and cardiovascular disease that may impact their diabetes management. This guide offers in-depth information about diabetes that will help you understand the disease and provide the best possible care as a CDPAP caregiver.
What is Diabetes?
Diabetes is a long-lasting health condition that causes high blood sugar levels. A person is considered to have diabetes when the fasting blood sugar level exceeds 126 mg/dL (7 mmol/L).
Having too much sugar in the blood for extended periods of time can cause serious health problems and life-threatening conditions, including:
- Heart disease
- Heart attack
- Stroke
- Coronary artery disease
- Nerve damage
- Kidney disease
- Eye damage
- Hearing impairment
- Skin conditions
- Depression and anxiety
- Dementia.
Insulin
When you eat or drink, your body breaks down the carbohydrates and releases a type of sugar called glucose into the bloodstream. As the glucose level increases, the pancreas releases insulin, a hormone that enables the cells to absorb the sugar and use it for energy.
The main role of insulin is to control blood glucose levels. When there is too much sugar in the blood, the excess is stored in the liver and released as soon as blood sugar levels drop.
In people who have diabetes, the body doesn’t produce enough insulin or any insulin at all. As a consequence, the pancreas can’t release sufficient amounts of the hormone when glucose enters the bloodstream. That’s why glucose accumulates in the blood and never reaches the cells, potentially causing health complications.
Insulin resistance
Insulin resistance occurs when the cells in your body don’t respond well to insulin. The pancreas has to work increasingly hard to keep your blood sugar levels down and over time its ability to release insulin decreases. Insulin resistance may cause prediabetes, type 2 diabetes, and many other serious health issues.
Type 1 vs type 2 diabetes
The two most common types of diabetes are type 1 and type 2 diabetes.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease. It occurs because your immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas, leaving you with little or no insulin. This type of diabetes is usually diagnosed in children and young adults.
People who have a parent or sibling with diabetes and those who carry genes linked to the disease are at a higher risk of getting type 1 diabetes.
Type 2 diabetes
If you have type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Unlike type 1 diabetes, it results from a combination of genetics and lifestyle factors, for example:
- Being age 45 or older
- Being overweight, especially having extra fat stored in the liver and abdomen
- Having prediabetes
- Having had gestational diabetes during pregnancy
- Having high blood pressure
- Having high cholesterol or high triglycerides
- Having polycystic ovary syndrome
- Having a sedentary lifestyle with little physical activity
- Having a family history of diabetes
- Having African American, Asian American, Hispanic, Alaska Native, Pacific Islander, or American Indian ancestry.
Type 2 diabetes can be developed at any age, but in the majority of cases it affects older people.
Signs of diabetes
The signs of diabetes vary largely from individual to individual. In addition, while people with type 2 diabetes may not have any symptoms at all, those with type 1 diabetes tend to experience more severe symptoms.
The common signs of both types of diabetes are:
- Increased thirst
- Frequent urination, particularly at night
- Extreme fatigue
- Irritability
- Blurred vision
- Unexplained weight loss
- Sores and wounds take longer to heal
- Frequent gums or skin infections
- Presence of ketones in the urine.
Diabetes in Seniors
Diabetes has a higher prevalence among the elderly due to increased insulin resistance and the weakened function of the pancreas with age.
Diabetes is also more frequent among people of certain ethnic backgrounds, as shown in the table below:
| Ehtnic background | Rate of diagnosis |
| White non-Hispanic individuals | 7.5% |
| Asian Americans | 9.2% |
| Hispanic individuals | 12.5% |
| Black non-Hispanic individuals | 11.7% |
| American Indians and Alaskan Natives | 14.7% |
Prediabetes
Prediabetes is an early stage of type 2 diabetes where blood sugar level is between 100 and 125 mg/dL (5.6 to 6.9 mmol/L). Prediabetes may be an indication that high glucose blood levels have already started affecting the heart, blood vessels, and kidneys.
About one out of every three adults in the United States are estimated to have prediabetes. People with genetic or lifestyle risk factors such as obesity and sedentary lifestyle are more likely to develop prediabetes.
Fortunately, it is possible to prevent and slow down the progression of prediabetes by introducing simple lifestyle changes.
Tips To Reverse Prediabetes
Eat healthy diet
Prediabetes can be slowed down and even reversed by switching to a nutritious and balanced diet that includes a variety of vegetables, fruits, whole grains, low-fat dairy products, and lean proteins. At the same time, it is important to avoid processed, fried, and sugary foods.
Lose weight
People who are overweight are recommended to lose about 5-7% of their body weight to lower the risk for developing type 2 diabetes.
Exercise regularly
Regular exercise plays a crucial role in preventing diabetes. It is recommended to do at least 30 minutes of moderate physical activity, such as walking, riding a bike, or swimming, five times a week.
Read on to learn more about different treatments for diabetes.
Treatment for Diabetes
Type 1 diabetes
The main treatment for type 1 diabetes consists of taking insulin to compensate for the hormone that the pancreas is not capable of producing. Although insulin therapy is demanding, it is an effective way to lower blood glucose levels.
Insulin can be administered either by injections or through an insulin pump. It is not possible to take it orally since stomach enzymes would break it down before it reaches the bloodstream.
Injections
Insulin is injected into the fat just below the skin with a syringe and needle or a pen-like device. The frequency of injections depends on the type of diabetes, your blood sugar levels, and how often you eat. While some people only need to take long-acting insulin once a day, others require taking short-acting or mealtime insulin several times a day.
Insulin pump
An insulin pump is a device that continuously pushes small doses of rapid-acting insulin through a thin tube inserted under the skin. There are several different kinds of insulin pumps available, including tethered pump, patch pump, implanted insulin pump (IIP), and the closed-loop insulin pump (artificial pancreas) that uses a smartphone app to automatically adjust insulin delivery based on the readings from a glucose sensor.
Lifestyle changes
For optimal effect, type 1 diabetes treatments have to be accompanied by healthy lifestyle choices such as eating a balanced diet, exercising regularly, and maintaining a healthy weight.
Medications
A physician may prescribe additional medications for people with type 1 diabetes who suffer from coexisting health conditions, such as high blood pressure medications, cholesterol-lowering drugs, and aspirin for patients with an increased risk of heart disease.
Type 2 diabetes
Unlike type 1 diabetes that has to be treated with insulin, in most cases, type 2 diabetes can be managed by a healthy diet and regular exercise. Your patient’s health care team will create a management plan that includes the following:
- Healthy nutrition
- Physical exercise
- Testing blood sugar frequently
- Tracking glucose levels
If lifestyle changes alone are not enough to lower blood sugar, the patient might need to take medications. Some people with type 2 diabetes may also need insulin therapy if their blood sugar levels are not well managed with oral medications.
Although there is no cure for diabetes, it is possible to significantly reduce the risk of complications by maintaining healthy habits.
Staying Healthy With Diabetes
With some self-care measures and lifestyle adjustments, it is fully possible to live a healthy life with diabetes. Below, we list some of the steps your patient can take to minimize the risk of developing diabetes-related complications.
Manage blood sugar
People with diabetes should maintain their blood glucose levels as close to normal as possible to delay or prevent complications. In general, the targeted daytime glucose levels before meals are between 80 and 130 mg/dL (4.44 to 7.2 mmol/L) and after-meal up to 180 mg/dL (10 mmol/L). Blood sugar levels can be tracked by a blood glucose meter.
Manage cholesterol
Individuals with diabetes often have high levels of “bad” (LDL) cholesterol and triglycerides, which can lead to heart disease and stroke. To attain healthy cholesterol levels, it may be necessary to adjust eating and exercise habits in addition to taking cholesterol-lowering medications.
Manage blood pressure
People with type 2 diabetes who suffer from high blood pressure are at an increased risk of having a heart attack or stroke. They are usually required to take medications that will keep their blood pressure below 130/80 mm Hg.
Stop smoking
Smokers who have diabetes are more likely to have very high blood sugar levels, making it harder to control their diabetes. They also risk suffering from heart disease, stroke, eye disease, kidney disease, blood vessel disease, as well as nerve damage.
Manage stress
When the body is under stress, the adrenal glands trigger the release of glucose stored in various organs, which may result in elevated levels of glucose in the bloodstream. As part of diabetes management, it is important to find ways to relieve stress, for example, practicing deep breathing, yoga, or meditation.
Get yearly eye exams
People with diabetes are recommended to get an annual eye exam to check for diabetes-related eye diseases, such as diabetic macular edema and retinopathy.
Schedule yearly kidney exams
People with diabetes may experience kidney failure because elevated blood sugar levels can damage the blood vessels in the kidneys. That’s why it’s essential to have urine tested regularly for early signs of kidney disease. Some people also need to take medications to help prevent further kidney damage.
Get flu and pneumonia vaccine
People suffering from diabetes are at a high risk of flu and pneumonia complications since elevated blood sugar levels may impair the ability of white blood cells to fight infections. Anyone who is over the age of 65 and has diabetes is recommended to get the yearly flu and pneumonia vaccine.
Take care of teeth and gums
High blood glucose levels can cause plaque buildup, gingivitis, as well as advanced gum disease. Patients with diabetes should make sure to properly brush and floss their teeth, in addition to getting regular dental checkups at least twice a year.
Ensure proper skin care
Diabetes can lead to various types of skin disorders, such as diabetic dermopathy, bacterial and fungal infections, and vitiligo. Proper skin care, especially keeping skin dry and taking care of cuts and bruises to prevent infections, is crucial for reducing the risk of skin-related problems.
Check feet for red patches
Diabetes may cause foot-related problems, such as nerve damage (diabetic neuropathy) and peripheral vascular disease. What’s more, ingrown toenails, cuts, and sores on the feet can lead to serious infections. Proper foot care is, therefore, necessary for people with diabetes. It is important to consult a podiatrist as soon as your patient notices red patches, sores, blisters, breaks in the skin, infections, or calluses on their feet.
Keep up with cancer screenings
People who live with diabetes are at increased risk of certain types of cancer, including liver, pancreatic, colorectal, breast, and bladder cancer. It is advisable to get appropriate cancer screenings based on the age, gender, and other risk factors.
Talk to the medical team
Your patient’s medical team will typically make a yearly assessment of their diabetes management plan. However, if your patient has any questions or concerns or might need help with their management plan, you should encourage them to talk to their health care provider.