Diabetes in the elderly – A different animal

Given our successful focus on pregnancy during he past few weeks, I thought perhaps we could continue with looking at Diabetes in specific groups of people. Over the past few weeks I have seen a number of elderly folks in my clinic, hence the inspiration for this week’s topic. Now, before all you young people start talking about how old you feel, or the older population get annoyed because I refer to them as “elderly,” let’s make a definition: for the purposes of this article, I refer to anyone over the age of 70 as “elder.”{{more}} I do not imply anything other than age in this definition, so I do not expect all of the “elderly” to be seated at home watching the grass grow outside. I have learned over the years that the lifestyles of patients can be immensely varied at any age group, so I bring no expectations in regard to your lifestyle. But it is important to address this issue because there ARE some well-accepted changes that occur in our bodies as we get older, and this does affect diabetes management.

So what happens as we get older? Nope, stop all the jokes about skin and hair falling etc. Not those changes, please. In regard to diabetes, there are a few important biological changes that happen overall. First, we become less able to handle glucose as effectively as when we were younger. This is one of the main reasons why older people are more likely to have diabetes than younger ones.

Second, we tend to gain weight more easily as our metabolism slows down with increasing age-unlike when you were a teenager, you just can’t eat what you want anymore without it showing up somewhere, your belly, your bottom…. In fact it is estimated that after age 30 years (whoops, that means me) people will gain an average of half a pound a year. Doesn’t sound like much but if you live to be 70, then you have another 20 pounds headed your way, AT LEAST. Not a pretty picture, right?

Third, kidney function drops as we get older, just as a normal part of aging. This is particularly important when considering diabetes medications, because some will be processed through the kidneys and be less appropriate for older people than younger ones.

Fourth, as we get older, our ability to quickly adjust or recover from various physical insults becomes reduced. This has impact in many areas of life, but notably with regard to low blood sugars in diabetes. Low blood sugars are harmful at any stage, but in older people it can be even more so: for example, someone 20 years old has a low blood sugar and falls. What happens? Maybe some bruises, a cut somewhere. Now take someone over 70 who has a low blood sugar and falls. What happens here: broken hips, broken legs etc. Believe me, neither your doctors or me want ANYBODY falling from low blood sugars, but we all agree it can be even more devastating when you are older.

We’ll continue on this topic next week. Please send any specific questions my way. Until next week, stay healthy, Vincies!

“Beautiful young people are accidents of nature, but beautiful old people are works of art.” – Eleanor Roosevelt

Anita Ramsetty, MD
endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227