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Diabetes in the elderly: what’s our goal here?

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Everyone can agree that in many ways someone over the age of 70 can be very different than those much younger. And so, when you start talking about diabetes management the goals can be a bit different. However, the details may surprise you.{{more}}

Let’s go through a few here that are specific to medications:

Choice of medications will change. As we discussed last week, kidney function starts to decline as you get older, just as a part of normal aging. Several of the diabetes pills on the market should only be used when kidney function is very good. You can think of your kidneys like a sink, and the medications are like soap bubbles. If the sink if draining well, the bubbles will drain away like they should. But if the sink is not working properly then the bubbles build up. Get the picture? So the medications themselves do not directly hurt the kidneys really, but rather because the kidneys cannot get rid of the medications as normal, those little pills “build up” in the bloodstream. The longer you have the medications in your blood and the higher the amount, the more likely you are to have repeated low blood sugars. This is why some diabetes pills are almost never used in older individuals. So, unfortunately, options for medications are more limited as we get older just out of safety concerns.

Use of insulin may increase. This is a bit of a follow up to the point above. Because we are less able to use diabetes pills, this means insulin is more likely to be used instead. This happens not only because of the kidney issue we talked about above, but also because the longer you have diabetes the less likely your pills will work adequately. In addition, some pills should not be used if you have heart problems that cause leg swelling or fluid in the lungs, so that cuts some other options out. I know it seems a bit unfair to have fewer options and sometimes need to go straight to insulin, but again, this is for your safety. So do not be surprised if your doctor moves to insulin faster than you expected.

Targets (where you want your blood sugar to be) for blood sugar will loosen up. Yaah! You say to yourself. Hold up there. I’m not saying that blood sugars in the 200’s (11.1 mMol/L) all day will be okay, but doctors are much less likely to push your blood sugars as low as they would if you were in your 40’s. Why? Because the risk of low blood sugars when you are older are potentially worse than when you are younger. I routinely write out blood sugar targets for my patients, and those who are older all have targets that are higher, especially before they go to bed. For example, in general I would like my patients to go to bed with blood sugars under 150mg/dL (8.33 mMol/L) BUT for my older patients I ask that their blood sugars be less than 200mg/dL (11.1 mg/dL).

So these are a few points for this week. Next week we’ll go through some more general aspects about diabetes that become more important for older folks, although it must be kept in mind for all of us. Until then stay safe and healthy, Vincies!

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227