Ageing brings mental and physical changes that can affect hearing, sight, memory and mobility, and if you have an elderly loved one with diabetes, it can be difficult to tell the difference between the signs and symptoms caused by the disease, and those that are part of the natural ageing process.

In this article, we’ll explore some effective solutions for managing diabetes in the elderly.

What is diabetes?

If an elderly family member has diabetes, it means their body can’t maintain a healthy level of glucose in their blood. Glucose is a form of sugar and our primary source of energy, and it is converted from food in our cells. The hormone insulin is essential for this process, because it helps move glucose from our blood into our cells. For people with diabetes, their pancreas doesn’t produce enough (or any) insulin, which prevents glucose from being moved into their cells, and creates dangerously high blood sugar levels.

There are three main types of diabetes — Type 1, Type 2 and gestational or pregnancy diabetes. For seniors, Types 1 and 2 can be dangerous or even fatal. 

What is Type 1 diabetes?

Type 1 diabetes is an autoimmune disease where the body destroys the cells that produce insulin in the pancreas. Only 10 to 15% of people with diabetes have Type 1. It can occur at any age, but often occurs in people under 30. It requires them to take daily insulin with an insulin pump, pen device or a syringe. Insulin may need to be administered once a day or several times a day, depending on their needs.

What is Type 2 diabetes?

In Type 2 diabetes, the pancreas is not producing enough insulin, or it is not working well enough. Type 2 diabetes affects 85 to 90% of all those with diabetes. It can occur in younger people, but it is most common in adults — up to 25 per cent of those over 65 have this disease. In terms of managing type 2 diabetes in the elderly, many who are diagnosed will eventually need glucose-lowering medication. This is especially true when the disease has progressed to a point where their levels can no longer be effectively managed by physical activity and diet alone. Over 50 per cent of those with type 2 diabetes may eventually need insulin.

What are the signs and symptoms of diabetes?

The signs and symptoms of diabetes in older people can be random, so may not be as obvious as they are in younger people. They can also relate to other conditions, which can delay diagnosis. Signs and symptoms in older people that may indicate diabetes include:

  • Extreme thirst
  • Blurred vision
  • Extreme tiredness
  • Having wounds that are slow to heal
  • Confusion or cognitive changes
  • Unexplained weight loss
  • Frequent incontinence or urination

Diabetes can be diagnosed by monitoring blood glucose levels, and managing diabetes in the elderly requires a balance between physical activity, healthy eating and/or the taking of tablets or insulin.

How is blood glucose monitored?

The main aim of treating diabetes is to keep blood glucose levels (BGLs) within a specific range. This helps to prevent high or low hypoglycaemic (blood sugar) levels. An individual’s recommended range may change over time with their health needs, and diabetes in elderly adults can change as they age.

BGLs are checked using a blood glucose meter. The finger is pricked to obtain a small drop of blood, and is placed onto the test strip in the meter, which produces a BGL reading. The frequency and timing of monitoring may also need to be reviewed at certain times, such as during illness. Doctors will therefore often recommend longer-term testing, which involves an A1c or a Haemoglobin A1c (HbA1c) test. 

What is hypoglycaemia?

Often known as “hypo”, hypoglycaemia means a person has low BGLs. Risk factors include having a poor appetite, skipping meals or fasting, being on multiple medications at a time, or having kidney disease or other conditions.

The specific signs and symptoms of hypoglycaemia include:

  • Sudden dizziness or weakness, particularly in the legs (“jelly legs”)
  • Hunger and/or a tingling around the mouth and face
  • Sweating — usually a cold sweat
  • An abnormally fast heart rate or heart palpitations
  • Feelings of unspecified fear or anxiety
  • Poor concentration
  • Drowsiness 

What is hyperglycaemia?

Hyperglycaemia means a person’s BGLs are too high. Risk factors include inadequate diabetes medication or insulin, a decrease in activity, emotional stress, and infection, illness, pain or injury.

The specific signs and symptoms of hyperglycaemia include:

  • Increased thirst (although this is often absent in older people)
  • Oral or genital thrush
  • Drier than normal lips and skin
  • A urinary tract infection
  • Increased or excessive amounts of urine
  • Poor healing of wounds
  • Blurred vision
  • Abnormal fatigue
  • Abnormal vagueness or disinterest
  • A fruity smell on the breathe (in people with type 1 diabetes)

Are there complications with diabetes?

Managing diabetes well can reduce its severity and help to prevent or delay diabetic complications, which include:

  • Heart attack, heart failure and stroke
  • Problems with vision
  • Kidney disease and kidney failure
  • Decreased blood supply to the legs
  • Gastrointestinal problems
  • Sexual health problems
  • Dental problems
  • Skin problems
  • Increased risk of deafness
  • Increased risk of infection
  • Increased risk of depression and Alzheimer’s                                        

How can diabetes be managed in the elderly?

Diabetes is a multifaceted condition that affects numerous body systems, however, it affects everyone differently. A diabetes care plan for the elderly will give sufferers and their carers better long-term control over the management of their condition. This includes regular appointments with doctors and other health professionals, and can consist of managing the following areas. 

Diet

As we age, it can be challenging to maintain healthy eating habits, because our appetites and lifestyles can change. However, ensuring your elderly parents maintain a healthy diet can help to control their cholesterol, blood pressure and blood glucose levels. You should help them eat a variety of foods, ensure they drink plenty of water, and their weight should be kept stable and suitable for their age, height and health.

Exercise

The ageing process, other health issues and the complications of diabetes can result in physical limitations that can affect an elderly person’s ability to exercise. But your loved ones are never too old to start exercising! It can increase mobility, help lower blood pressure and BGLs, reduce the risk of health problems, and improve their quality of life. It is recommended that all people do at least 30 minutes of moderate physical activity at most, and every single day if possible. This can include walking, swimming, dancing or even washing the car.

Foot care

Because the blood vessels and nerves to the feet can be damaged by diabetes, foot care is an essential part of a diabetes care plan for the elderly. Unfortunately, foot problems can contribute to a higher risk of falls, wounds or infections, and pain or the absence of pain in the feet. Daily foot hygiene should include washing and drying feet (especially between the toes), moisturising the skin, and ensuring they wear shoes that fit well and socks or stockings that aren’t too tight. 

Skin care

As our skin ages, it becomes thinner and loses moisture and elasticity, which makes it crack or tear more easily, with longer healing time. Unfortunately, having diabetes can speed up this process, and delay the healing process. Older people should avoid over-washing skin, use warm (not hot) water to wash, and use a non-soap cleanser or a pH-neutral soap. They should also pat skin dry rather than rubbing, and moisturise their entire body after washing. 

Eye care

Having diabetes can cause damage to the tiny blood vessels on the retina, which sits at the back of the eye. Older people should have regular optometrist eye examinations to detect problems early. This is particularly the case if they exhibit signs of eye pain, double vision, blurred vision, sudden sight loss, or swelling or redness of the eye or eyelid. Their glasses should also be clean and accessible, and they should wear sunglasses when outside. 

Oral care

Because people with diabetes have more glucose in their saliva, they can be prone to more gum disease and tooth decay. Regular dental check-ups should be organised, particularly if they show signs of a dry mouth, bleeding gums, ulcers, loose teeth, persistent bad breath, a change in the way they bite or chew, or if dentures are suddenly loose or uncomfortable. 

Mental health

Many older people face significant life changes that can put them at risk of depression and anxiety. These can include isolation, loneliness, fear about the future, bereavement and a reduced sense of purpose. Illnesses like diabetes can also take their toll, so it’s important to be aware of changes in attitude and behaviour. These include sadness, tiredness, interrupted sleep, a loss of appetite, and a reluctance to participate in activities. Their GP should be consulted if any of these are evident, and action taken as part of an overall diabetes care plan for your elderly loved one.

References

  1. 2016, Diabetes Management in Aged Care: Fast Facts for Care Workers, Diabetes Australia
  2. 2020, Managing Diabetes As You Age, National Diabetes Services Scheme