Diabetes mellitus (DM) is a growing public health issue prevalent in the United States geriatric population. According to the National Library of Medicine, almost 36% of the US citizens aged 65 or more are affected by diabetes mellitus.

Diabetes mellitus can increase the risk of developing diseases such as cardiovascular complications, hypertension, microvascular disorders, stroke, and many others. Let’s discuss the main symptoms, important tests for screening, management of this disease, and most importantly, prevention from complications associated with DM.

Main Signs and Symptoms of DM in the Elderly

In our old age, we may experience the following symptoms of diabetes mellitus:

  • Polydipsia (increased thirst)
  • Polyphagia (increased hunger)
  • Polyuria (Increased frequency of urination)
  • Generalized weakness, fatigue, and malaise.
  • Numbness or tingling sensations in the feet or hands.
  • Unexplained weight loss
  • Slow-healing wounds or cuts.

In the early stages of the disease, we may miss noticing the symptoms of DM.

Important Tests Used for Screening DM in Old Age

Screening for DM is essential as it is easy to control the disease and prevent ourselves from associated complications if it is diagnosed in its early stages. According to the American Diabetes Association‘s diagnostic criteria, the following tests are routinely used to diagnose DM.

  • HbA1c

HbA1c levels measure our average blood glucose values for the past 2 to 3 months. If HbA1c results show 6.5% or higher, we are diagnosed with DM. If the results are less than 5.7 %, we do not have DM. (5.7% to 6.4% range presents prediabetes.)

  • Fasting Plasma Glucose levels

Fasting plasma glucose levels are usually checked after not having anything to eat or drink (except plain water) for at least eight hours before the test. Fasting plasma glucose levels of more than or equal to 126 mg/dL fall under the category of diabetes.

  • Random Plasma Glucose levels

Random plasma glucose levels refer to the blood glucose levels checked at any time of the day. This test has less specificity as our glucose levels may become high after eating a carbohydrate-rich snack or meal. Random plasma glucose levels equal to or more than 200 mg/dL are placed under the diabetic range.

Management of Diabetes Mellitus

The main goal of DM management in old age is to keep the HbA1c levels equal to or less than 7%. However, a less stringent target of 8% is recommended in frail individuals with a life expectancy of fewer than five years. Following are the main ways to manage DM in the elderly,

  • Keep an eye on carbohydrate intake.

Our blood glucose levels mainly depend upon the carbohydrate content of our meals. We may need to adjust our insulin dose according to the carbohydrate content of our meals. Thus, it is essential to count our carbohydrate intake. For this purpose, we can use “The Diabetic Exchange List”, issued by American Diabetes Association.

  • Do regular physical activity.

Regular physical activity is the second most essential intervention to manage diabetes in the elderly. At least 150 minutes of moderate-intensity exercise should be done each week. Regular physical activity can manage our blood glucose levels as glucose molecules are generally utilized by the skeletal muscles during exercise.

We can also use the guide endorsed by Unified Organization to help ourselves overcome the barriers of regular physical activity.

  • Manage mental stress levels

Studies have revealed that mental stress levels are directly proportional to plasma glucose levels. Thus, we should mitigate our stress levels to keep our blood glucose levels in the range.

As we age, we should broaden our social circles, regularize our sleep cycles, and share our psychological stress with close ones or other older adults.

  • Medical management

Certain medications can be used to control diabetes in the elderly. However, it should be kept in mind that these drugs are not the ultimate treatment for DM. So, we need to use these drugs regularly.

These medications may include oral antidiabetic drugs (such as metformin, sulfonylureas, meglitinides, acarbose, pioglitazone, etc.) and insulin. A primary care physician usually adjusts the dose of these medications according to our blood glucose levels.

Prevention from Complications of DM

As mentioned above, uncontrolled DM can cause serious complications such as chronic kidney disease, retinopathy (that may lead to blindness), diabetic foot and gangrene, gum problems, and cardiovascular disorders. We can take the following measures to prevent ourselves from these complications of diabetes mellitus.

  • Monitor glucose levels regularly as persistently increased glucose levels can damage many body organs. For instance, glucose levels of more than 180 mg/dL can damage our kidney tissues. We should seek dose adjustment and modify our lifestyle if we have increased glucose levels on monitoring.
  • Screening tests for associated diseases. If we are affected by DM, we must regularly screen ourselves for other diseases associated with DM. These tests may include regular eye checkups, hearing tests, blood cholesterol levels, cardiac performance tests, etc. We can also use the Hearing app mentioned on Unified Organization’s website to test our hearing ability as we grow old regularly.
  • Regular feet and teeth inspections. Diabetes mellitus can damage the microvessels of feet can be damaged; that’s why we need to take extra care of our feet because the feet of diabetic patients are prone to gangrene and other diseases. Similarly, we should also take care of our mouth hygiene and teeth because they are at increased risk of infection in diabetes.
  • Get vaccinated against flu and other diseases because diabetes can increase the risk of getting many infections such as flu, pneumonia, etc. A yearly flu vaccine and pneumonia booster shot are recommended in diabetic older adults.

Take home

Diabetes Mellitus is a prevalent disorder in the US elderly population and can lead to serious outcomes. Generally, we may have polyuria, polydipsia, and polyphagia in DM and require certain screening tests for the diagnosis such as HbA1c, and random and fasting blood glucose levels. We should take certain measures to manage DM in old age, including a low glycemic diet, exercise, and medications.

We should also monitor glucose levels, inspect our feet and teeth regularly, and get vaccinated against flu, pneumonia, and other such diseases.

References:

  1. Laiteerapong, N., E. S. Huang, and N. Laiteerapong. “Chapter 16: Diabetes in older adults.” Diabetes in America (2018): 1-26.
  2. https://www.diabetes.org/diabetes/a1c/diagnosis.
  3. https://diabetesed.net/page/_files/THE-DIABETIC-EXCHANGE-LIST.pdf