Type 2 Diabetes in Seniors

By Jeannette Franks, PhD – Jeannette Franks, PhD, is a passionate gerontologist who teaches at University of Washington and Bastyr University; she is the author of a book on assisted living and numerous articles.

My career working with older people began 25 years ago at Community Services for the Blind, where friends, staff, volunteers and clients had lost their sight due to complications from diabetes. Some died at an early age. Today we know much more about the prevention, diagnosis and treatment of type 2 diabetes than we did then. Nevertheless, the disease has reached epidemic proportions in the U.S., afflicting more and more people at younger and younger ages. Type 1 diabetes affects 5% of all people with diabetes and occurs mostly in people under the age of 20. In this condition, the pancreas produces insufficient insulin to maintain normal glucose (blood sugar) levels.

The vast majority of people with diabetes have type 2 diabetes, which is characterized by hyperglycemia (excess blood sugar) and insulin resistance. It can cause not only vision loss, but kidney failure, nerve damage, cardiovascular (heart and other artery blockage) disease, as well as increased infections and slowed healing, sometimes resulting in the need for amputation. Type 2 diabetes in seniors is particularly problematic.

Type 2 Diabetes Symptoms

The most common initial symptoms of type 2 diabetes are increased thirst and frequent urination. Excess glucose in your bloodstream sucks water from tissues, forcing you to want to take in more liquid.

Type 2 diabetes is frequently asymptomatic for many years, before initial tell-tale signs of the disease emerge. These include:

• Flu-like Fatigue: Feeling lethargic, tired or chronically weak can be a sign of type 2 diabetes. When your body can’t process sugar properly, you’ll have chronically low energy.
• Blurred Vision: Excess levels of sugar pull fluid from the lenses of your eyes, affecting your ability to focus. If your vision ever changes noticeably over a brief period of time, see a physician immediately.
• Sores That Heal Slowly or Frequent Infections: Urinary tract infections are especially a problem for older people.
• Numbness & Tingling in Extremities: Decreased circulation can cause neuropathy (nerve damage). You may experience a lack of feeling in, or conversely, burning pain in your legs, feet, arms and/or hands.
• Gum Disease: Watch for increased senior dental problems and infections in your mouth. Type 2 diabetes can cause your gums to be red and inflamed, putting your teeth at serious risk.

How Type 2 Diabetes Affects the Body

In order to understand what causes diabetes, it’s helpful to first understand a little about how your body normally uses insulin. After you eat, your body breaks down carbohydrates from bread, rice, pasta, vegetables, fruits and other foods into sugar molecules, especially glucose. However, glucose cannot enter your cells without the help of insulin, which the pancreas produces continuously in a healthy individual. As the blood sugar increases after a meal, insulin production also increases. The insulin unlocks cells so that glucose can enter them. When a person has diabetes, either the pancreas doesn’t produce enough insulin, or cells begin to resist the insulin. When that happens, sugar can build up in the blood and begin to cause the symptoms described above.

Type 2 Diabetes Risk Factors

You may be at risk for developing diabetes if you have any of the following characteristics:

• Extra Weight: Excess fatty tissue increases the resistance to insulin. Even a small weight loss can be beneficial to many people with type 2 diabetes.
• Family History of the Disease: People with a parent or sibling with type 2 diabetes are more likely to have the disease. Genes don’t predetermine type 2 diabetes, but burden you with a predisposition to this disease.
• Age Over 45: Perhaps it is because we tend to exercise less and gain weight as we age. Perhaps the cells function less efficiently. Whatever the reason may be, the longer you live, the greater your risk.
• Stress & Depression: Another factor which can cause insulin production to malfunction is persistent high levels of stress. A December 2005 Scientific Americanan alysis of several research studies found that the stress of racism and poverty causes many physiological consequences, including increased insulin production and resulting increase of type 2 diabetes.

It’s likely that all of these factors interact. While having one risk factor may not make it likely that you’ll develop the disease, if you have three or four risk factors, you’ll need to be extra vigilant about maintaining a healthy lifestyle.

Type 2 Diabetes Diagnosis & Potential Complications

Often people discover that they have type 2 diabetes after going to the doctor for something else altogether. Both the American Diabetes Association and the American Academy of Family Physicians recommend a fasting glucose test after age 45, and if normal, every 3 years thereafter. You might want to begin screening earlier if you have any of the risk factors above.

Complications, if type 2 diabetes is not controlled, include:

• Retinopathy (Eye Damage): Uncontrolled type 2 diabetes can lead to vision loss. The majority of people with diabetes will experience deterioration in the blood vessels of the retina. Diabetes is the leading cause of blindness of adults age 20 to 74.
• Nephropathy (Kidney Damage): Kidneys filter the blood and eliminate waste excreted in urine, and diabetes can damage this delicate system. Kidney damage is manifested in swollen hands, feet, and ankles; anemia; shortness of breath and high blood pressure. Severe damage results in permanent loss of kidney function and end-stage renal disease.
• Cardiovascular Disease: Diabetes significantly increases your risk of heart attack and stroke. It may also lower your good cholesterol (HDL) and raise your bad cholesterol (LDL).
• Infections: Glucose levels affect your immune systems and ability to fight off bacteria and viruses, in addition to impairing circulation to heal infected tissue.
• Neuropathy (Nerve Damage): Some people with diabetes may eventually experience nerve damage. Numbness, tingling, and that feeling that an area has “gone to sleep” are signs of sensory nerve damage. Because extremities lose sensitivity and injuries may go unnoticed, serious damage from minor sores or abrasions can be a major problem, especially in the feet.

Natural Treatment & Prevention of Type 2 Diabetes

If you feel you may be at risk for developing type 2 diabetes, or you’ve been newly diagnosed, there are several simple things you can do to help manage your health:

• Lose Weight: This may sound simplistic, but the two major causes of type 2 diabetes in seniors are eating too much and exercising too little. The best way to prevent it is to eat less and exercise more, but this is understandably more difficult than it sounds in today’s modern world.
• Eliminate Fat & Sugar from Your Diet: A nutritionist may counsel you in making dietary changes. Generally speaking, people with diabetes are advised to increase intake of vegetables and whole grains and to decrease animal fats and sugars.
• Eliminate Stress: Try to schedule entire days where you do only things that you enjoy. Relaxing practices such as meditation, tai chi, yoga and Nia (a dance form) can be very effective in reducing daily stresses, as can having regular massages.

Medications for Type 2 Diabetes

If diet and exercise are insufficient, numerous drug options help manage type 2 diabetes in seniors. Major commonly-used medications for type 2 diabetes:

• Sulfonylureas: This class of drugs is the mainstay of treatment for type 2 diabetes. Sulfonylureas stimulate the pancreas to make more insulin. People who respond best to this treatment are those who were diagnosed before the age of 40 or have had the disease for less than 5 years. Brand names include Orinase®, Glucotrol®, DiaBeta®, Glynase® and Micronase®.
• Metformin, Brand Name Glucophage®: This medication lowers blood glucose by decreasing output and reducing insulin resistance. Extreme caution is advised if you have chronic obstructive pulmonary disease, congestive heart failure, moderate illness or excessive alcohol use.
• Alpha-Glucosidase Inhibitors: Brand names Precose® and Glyset®; this drug inhibits the breakdown of complex carbohydrates. Use should begin gradually to minimize flatulence.
• Thiazolidinediones, Also Called Glitazones: The most common brand names are Actos® and Avandia®. These drugs make your body tissues more sensitive to insulin. Side effects include swelling, weight gain, and fatigue
• Meglitinides, Brand Name Prandin®: Similar to sulfonylureas, these are less likely to develop low blood sugar. This drug works quickly, but is less long lasting than other medications.

There are many other medications as well, and often these drugs are used in combination. It is extremely important to find a health-care provider to explain the advantages and disadvantages of the different approaches to treatment so that you can fully understand your options.