Diabetes is detected by measuring the amount of glucose in the blood after an individual has fasted (abstained from food) for about eight hours. In some cases, physicians diagnose diabetes by administering an oral glucose tolerance test, which measures glucose levels before and after a specific amount of sugar has been ingested. Another test being developed for Type 1 diabetes looks for specific antibodies (proteins of the immune system that attack foreign substances) present only in persons with diabetes. This test may detect Type 1 diabetes at an early stage, reducing the risk of complications from the disease. The prevalence of diabetes continues to increase steadily as more people live longer and grow heavier. The overall prevalence of diagnosed cases of type 2 diabetes rises from 1.4 percent between the ages 25 of 44 years to 3.6 percent between the ages of 45 and 54 years, 7.8 percent between the ages of 55 and 64 years, and over 10 percent over the age of 65 years.
Individuals with Type 1 diabetes require insulin injections, often two to four times a day, to provide the body with the insulin it does not produce. The amount of insulin needed varies from person to person and may be influenced by factors such as a person’s level of physical activity, diet, and the presence of other health disorders. Typically, individuals with Type 1 diabetes use a meter several times a day to measure the level of glucose in a drop of their blood obtained by pricking a fingertip. They can then adjust the amount of insulin injected, physical exercise, or food intake to maintain the blood sugar at a normal level. People with Type 1 diabetes must carefully control their diets by distributing meals and snacks throughout the day so as not to overwhelm the ability of the insulin supply to help cells absorb glucose. They also need to eat foods that contain complex sugars, which break down slowly and cause a slower rise in blood sugar levels. The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. However, in frail elderly patients with diabetes, avoidance of hypoglycemia, hypotension and drug interactions due to polypharmacy are of major concern. In addition, management of coexisting medical conditions is important as it influences their ability to perform self-management.
Although most persons with Type 1 diabetes strive to lower the amount of glucose in their blood, levels that are too low can also cause health problems. For example, if a person with Type 1 diabetes injects too much insulin, it can produce low blood sugar levels. This may result in hypoglycemia, a condition characterized by shakiness, confusion, and anxiety. A person who develops hypoglycemia can combat symptoms by consuming food that contains sugar, such as glucose tablets, fruit juice, or hard candy.
In order to control insulin levels, people with Type 1 diabetes must monitor their glucose levels several times a day. In 1983 a group of 1,441 Type 1 diabetics aged 13 to 39 began participating in the Diabetes Control and Complications Trial, the largest scientific study of diabetes treatment ever undertaken. The Diabetes Control and Complications Trial studied the potential for reducing diabetes-related complications, such as nerve or kidney disease or eye disorders, by having patients closely monitor their blood sugar levels four to six times a day, maintaining the levels as close to normal as possible. The results of the study, reported in 1993, showed a 50 to 75 percent reduction of diabetic complications in people who aggressively monitored and controlled their glucose levels. Although the study was performed on people with Type 1 diabetes, researchers believe that close monitoring of blood sugar levels would also benefit people with Type 2 diabetes.
A recommended meal is usually low in fat (30 percent or less of total calories), provides moderate protein (10 to 20 percent of total calories), and contains a variety of carbohydrates, such as beans, vegetables, and grains. Regular exercise helps body cells absorb glucose—even ten minutes of exercise a day can be effective. Diet control and exercise may also play a role in weight reduction, which appears to partially reverse the body’s inability to use insulin. Older adults may have more neuroglycopenic manifestations of hypoglycemia (dizziness, weakness, delirium, confusion) compared with adrenergic manifestations (tremors, sweating). These symptoms may be missed or misconstrued as primary neurological disease (such as a transient ischemic attack), leading to inappropriate reporting of hypoglycemic episodes by the patients. Hypoglycemic episodes in these individuals also increase the risk of adverse events with cardiovascular and coronary disease.
For some people with Type 2 diabetes, diet, exercise, and weight reduction alone may work initially, but eventually this regimen does not help control high blood sugar levels. In these cases, oral medication may be prescribed. If oral medications are ineffective, a person with Type 2 diabetes may need insulin injections or a combination of oral medication and insulin injections. About 49 percent of individuals with Type 2 diabetes require oral medications, 40 percent require insulin injections or a combination of insulin injections and oral medications, and 10 percent use diet and exercise alone.
All of the types of oral hypoglycemic drugs and insulin are safe in older patients, although each has some limitations.
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