Health & Fitness

For the elderly, diabetes presents more complications

When Ronald Beasley, an Army veteran, was diagnosed with Type 2 diabetes four years ago, he had to drastically change his lifestyle.

Compounding his issue: At 56, he had several other health conditions he was battling.

“I have high blood pressure, high cholesterol. I take other medications and the doctors coordinate,” Beasley said. “They try hard to help patients.”

One of Beasley’s doctors at the Miami Veterans Administration Healthcare System, Dr. Hermes Florez, has taken a special interest in treating older patients with diabetes. Diabetics are at risk of developing cardiovascular disease, kidney problems, neuropathy and slow healing of open wounds — all of which can lead to more complications as they age.

“We are facing an epidemic number of diabetics in the nation,” said Florez, an associate professor in the departments of medicine and epidemiology at the University of Miami Miller School of Medicine and clinical director of geriatric research at the Miami VA. “In South Florida, the patients at high risk are the aging population.”

Type 1 diabetics are usually diagnosed when they are children. In Type 1, the body does not produce insulin. This affects only about 5 percent of all U.S. diabetes cases.

Type 2 diabetes, which affects about 95 percent of all cases, stems from the body not using insulin properly. At first, the pancreas makes extra insulin to make up for it. But, over time the pancreas can't make enough insulin to keep your blood glucose at normal levels.

Type 2 diabetes is directly influenced by sedentary lifestyles and poor eating habits.

“As we age, we lose muscle mass. Then people gain fat to replace the muscle loss,” Florez said.

The National Diabetes Prevention Program, led by the Centers of Disease Control and Prevention, recommends that anyone over age 45 should be screened for prediabetes. Prediabetics have unusually high blood sugar levels, but not high enough to be diagnosed as diabetic yet. One in every three adults had prediabetes in 2010, according to the CDC.

Florez recommends that his patients exercise — at their own pace and ability — five times a week for about 30 minutes. That includes walking, jogging, bicycling, swimming, exercise classes — anything to keep you moving.

Eating healthy meals — more fruits, vegetables, lean protein and smaller portion sizes, while reducing sugar and processed foods — can also delay or prevent Type 2 diabetes.

The CDC, for example, conducted a study among 3,234 participants who were overweight and had prediabetes. Of those, 45 percent were from minority groups who are at increased risk of developing diabetes — African American, Alaska Native, American Indian, Asian American, Hispanic or Pacific Islanders.

The study found that people can delay and possibly prevent Type 2 diabetes by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity five days a week and healthier eating. These lifestyle changes helped reduce the risk of developing Type 2 diabetes by 58 percent, the study showed. Furthermore, the lifestyle changes worked particularly well for those aged 60 and older, reducing their risk of developing diabetes by 71 percent.

Dr. Osnat Shmueli, a family medicine doctor at Baptist Health Medical Group, said that sticking to a healthy diet and exercise routine tends to be easier for patients with Type 1 diabetes, because they start learning to keep their disease in check at a younger age.

“It’s hard to change habits if you aren’t used to it,” she said. “Becoming active is hard to incorporate into their lifestyle. So I recommend they start slowly,” she said.

For patients who are just starting to exercise regularly, she suggested they try anything that will get their heart rate up.

“If they’re watching TV, they can walk around between commercials,” she said.

Or with the cooler weather, go outside for a walk.

Shmueli said treating older and more frail patients with diabetes is different from treating younger, healthier diabetics. The biggest difference, Shmueli said, is that sometimes older patients are more susceptible to other health conditions, like cardiovascular disease and kidney disease, so doctors have to be careful what medication they prescribe,

Older patients are also at risk for cardiovascular issues, putting them at high risk for a heart attack or stroke. Regularly monitoring high blood pressure and cholesterol levels are critical.

Older people with diabetes also can develop hypoglycemia, when their blood sugar levels get so low that they develop nausea, clammy hands, fatigue, seizures and can even faint. For the elderly, hypoglycemia can be dangerous because it can lead to falls, depending on the severity of the episode, Florez said.

Another concern with older patients is screening them for depression and cognitive decline. Sometimes, diabetes can trigger depression; in other cases, depression can lead to diabetes.

If a family member is becoming forgetful or can’t administer their medication or insulin on their own, Shmueli said, then they should rely on a family member, friend or neighbor for help. Additionally, Shmueli would consider switching the patient to long-lasting insulin medication — meaning fewer pills and shots to administer every day.

Beasley volunteered to be part of a fairly new national study, the Glycemia Reduction Approaches in Diabetes, to test how different drug combinations help keep a balanced glucose, or blood sugar, level. Florez is leading the research in Florida as part of the study, which is funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

Well-controlled patients, like Beasley, visit the Miami VA diabetes clinic every three months. Patients with frequent highs and lows need to visit more regularly, said Florez, about every two weeks or every month. In general, Florez said his patients take a real interest in monitoring their health and well-being.

“Some elderly patients come in with very sophisticated excel spreadsheets,” he said. “Patients can become experts and help other patients. Having a support network improves the overall quality of life and we want to empower the patient.”

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