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.
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:
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.
You may be at risk for developing diabetes if you have any of the following characteristics:
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.
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:
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:
If diet and exercise are insufficient, numerous drug options help manage type 2 diabetes in seniors. Major commonly-used medications for type 2 diabetes:
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.