World Diabetes Day 2022: Access to Diabetes Care.

The chronic effect of diabetes can be managed with the right treatment and lifestyle modification
Representational Image
Representational Image Wikimedia Commons/ Ofek Abuhazira

What is diabetes?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream.

Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease. Type 1 diabetes is usually detected at an early age, and the risk of developing type 2 diabetes is more commonly seen in older age groups.

The chronic effect of diabetes can be managed with the right treatment and lifestyle modification. The glucose level can be kept under control. The diabetes patient needs to be prepared to manage it in the long run without forgoing a normal life.

Common Symptoms of Diabetes?

3 P’s polydipsia, polyuria, and polyphagia (increased thirst, urination, and appetite). Other symptoms are unexplained weight loss, fatigue, irritability, and slow healing of injuries, among others. It is crucial to pay attention to any symptoms and not ignore them to detect diabetes early and start treatment immediately.

Symptoms of Diabetes in the Elderly?

Diabetes onset in the elderly usually manifests with vague and not specific symptoms, such as dehydration, dry mouth, confusion, fatigue, lethargy, weight loss, and an increased tendency toward genitourinary infections.

Most of the elderly with diabetes have at least one other comorbid disease like high blood pressure or/and high LDL cholesterol. Other type 2 diabetes comorbidities in the elderly, include cognitive impairment, disability, depression, apathy, urinary incontinence, polypharmacy, hearing, and visual impairment, falls and fractures. These are usually called geriatric syndromes. 

What are Geriatric Syndromes?

Geriatric syndromes include a number of conditions typical of, if not specific to, ageing, such as dementia, depression, delirium, incontinence, vertigo, falls, spontaneous bone fractures, failure to thrive, and neglect and abuse. With advanced age, malnutrition, physical inactivity, and unwanted weight loss become more frequent.

Moreover, elderly diabetic patients are more likely to experience severe or unaware hyperglycemia or  severe hypoglycemic episodes and major adverse cardiovascular events.

Therefore, a comprehensive geriatric assessment including screening for microvascular complications, cardiovascular risk factors, and geriatric syndromes should be performed at the initial diagnosis of diabetes in elderly patients. 

Atypical symptoms of Diabetes in the Elderly?

If any elderly experiences confusion, falls, failure to thrive, neuropathy, coronary artery disease, visual symptoms or coma, should be evaluated for diabetes.

Why are the Elderly more prone to Diabetes?

Factors that contribute to the high prevalence of Diabetes are Age-related changes in glucose metabolism, Obesity Sarcopenia (insulin resistance), Reduced physical activity, Unhealthy diet, Polypharmacy, Coexisting illness, Autoimmune phenomena, Genetics and Longevity. 

Does uncontrolled sugar accelerate the process of ageing?

Yes, uncontrolled blood sugar leads to several complications and affects many organs resulting in an accelerated ageing process.

What are the risk factors for Diabetes?

MODIFIABLE RISK FACTORS: Physical inactivity, Overweight/obese, Poor dietary habits, Smoking, Alcoholism, Certain medications eg steroids.

NON-MODIFIABLE RISK FACTORS: Genetics, Family history, Race/ethnicity, Hypertension, Increasing age, dyslipidemia. 

Risk Factors for Diabetes

How is Diabetes diagnosed?

There are many blood tests to diagnose diabetes. Each way usually needs to be repeated on a second day to diagnose diabetes.

Fasting Plasma Glucose (FPG)/Fasting Blood Sugar (FBS)

Fasting means not having anything to eat or drink for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.

Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl

HBA1C

The HBA1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don’t have to fast or drink anything.

Diabetes is diagnosed at an A1C of greater than or equal to 6.5%

Oral Glucose Tolerance Test (OGTT)

The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.

Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl

Random (also called Casual) Blood Sugar (RBS)

This test is a blood check at any time of the day when you have severe diabetes symptoms.

Diabetes is diagnosed as a blood glucose of greater than or equal to 200 mg/dl

What is Prediabetes?

Before people develop type 2 diabetes, they almost always have prediabetes—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Doctors sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when it was detected. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

What are the symptoms of prediabetes?

There are no clear symptoms of prediabetes, so you may have it and not know it.

Some people with prediabetes may have some of the symptoms of diabetes or even problems from diabetes already. You usually find out that you have prediabetes when being tested for diabetes.

If you have prediabetes, you should be checked for type 2 diabetes every 3 months.

Results indicating prediabetes are:

     An HBA1C of 5.7–6.4%

◊     Fasting blood glucose of 100–125 mg/dl

◊     An OGTT two-hour blood glucose of 140–199 mg/dl

 

How to manage diabetes?

Diabetes management consists of 4 M’s.

Meals: Low sugar diets and eating smaller, more frequent meals, and possibly even snacks are recommended. Encourage taking vegetables and fruits and avoiding salt, sugars and fats. Talk to your doctor about the diet chart.

Movement: Regular exercise or brisk walking for 30 min/day at least 5 days a week is recommended. This also helps in weight management.

Medication: When your sugars are not controlled with diet and exercise, you need medicines to keep your blood sugars in control. There are oral medicines and insulin that are given to the patients. Talk to your doctor about newer medicines for diabetes that also help in weight loss and are heart, kidney and liver-friendly.

Monitoring: Depending on your treatment plan, you may check and record your blood sugar level every now and then or multiple times a day. Since the elderly have compromised heart and kidney functions, ask your doctor how often you should check your blood sugar.

All four modalities are equally important for the proper control of diabetes.

What are the complications of diabetes?

Complications of diabetes usually occur due to uncontrolled blood sugar, taking unhealthy food and lack of exercise. The complications include diabetic kidney disease, retinopathy, peripheral neuropathy, Coronary heart disease and heart failure, Stroke and Peripheral vascular disease.

There are certain emerging complications of diabetes usually seen in the elderly like Cancer, Infections, Liver disease, Functional disability, Cognitive disability and Affective disorders.

What are the tips to keep Diabetes at bay?

Don’t stress yourself on pity issues. Do not skip breakfast. Eat plenty of fruits and vegetables. Replace the pack of chips with some nuts. Limit aerated and sweetened drinks. Choose green tea instead. Reduce rice and increase vegetables. Add fibre like whole grains and beans to your plate. Eat small but frequent meals. Exercise daily. Better to eat home-cooked meals instead of instant meals or fast food. Avoid processed and refined foods. Limit cakes and other bakery items. Be sure to get 6-7 hours of sleep. Reduce salt and fats in food. Regularly evaluate your blood sugar levels.

You are actually healthier after diagnosis of diabetes. Be a conscious lady of the home. Be mindful of how much Sugar, Salt and Oil you and your family consume. Most causes of diabetes are attributed to obesity, a sedentary lifestyle and poor eating habits.

What are the tips for the elderly to control diabetes in winter?

For many elderly with diabetes, as the temperature drops, blood sugars rise because cold weather keeps you inside, you may exercise less and eat more.

Tips:

Warm up your body: There are lots of ways to get active without ever leaving your home. Indoor mild exercises, walking in the corridor or big room or hall during winter lowers your blood sugar, helps your body use insulin better, keeps you warm, and can even improve your mood.

Stay healthy: If you do get any infection or cold, virus or flu,  your diabetes is more difficult to control. Make sure to get your flu shot, get 7-8 hours of sleep a night, wash your hands frequently, if you do get sick, stay home, and eat well.

Remember to count the carbs for ALL of the food that you are eating and dose your insulin correctly for what you eat. Home-made vegetable soups with lots of delicious veggies can help keep you warm and are often healthy choices. Avoid junk like like pizza or pasta and premade frozen dinners can be loaded with extra calories, salt and fat.

Keep your spirits up: During the winter, it can be more difficult to stay in touch with friends. Have a friend over. Simply talking can lift your mood and make you feel less isolated. Keeping active, counting the carbs that you eat and staying connected with others would help keep your blood sugar in control.

Dr Zubair is a Senior Geriatric Consultant.

DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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