Diabetes risks in Older Adults

What are some of the most common health concerns among aging type 2 diabetics, and how can they be managed?

By Dr. Sanjay Gupta

Type 2 diabetes can lead to serious health complications, and older people with the disease are especially vulnerable. The American Diabetes Association (ADA) estimates roughly 27 percent of people 65 years of age and older have diabetes, and studies have shown that the highest rates of diabetes-related heart attacks, kidney failure, and amputations are among older adults.

According to a 2012 report published by the ADA and the American Geriatrics Society, “diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization.” But many complications can be delayed or even prevented with treatment and lifestyle changes. Here are some of the most common health concerns among aging type 2 diabetics.

Limited Mobility

Everyone knows physical activity is key to overall health, especially for people with diabetes. Exercise helps regulate weight, improve cardiovascular health, and strengthen bones and muscle. A recent study in New Zealand suggests that short bursts of exercise before main meals may help control blood sugar levels. But aging can often limit mobility and physical activity, even for people accustomed to exercising.

Sam Penceal, 69, was diagnosed with diabetes almost 15 years ago. A former college basketball player, he was able to quickly jumpstart his fitness routine to help manage the disease. Though he still exercises three to five times a week, Penceal admits he now needs more time for his body to rest.

“I realize that I have to give my body more time to recoup,” said Penceal, who sits on the executive committee of the ADA’s Step Out Walk NYC and is captain of his Step Out Walk team. “If I exercise heavily two days in a row, it’s important I give my body a day of rest.”

If a person does not have a history of consistent exercise, precautions should be taken before beginning a new regimen.

“Because the risk of heart disease is higher in diabetic patients, I recommend those in the aging population talk with their physicians or even go through an exercise stress test to make sure their heart is okay for physical activity,” said Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic.

Diabetics are at a greater risk for joint and bone disorders, which can impact their ability to exercise. Dr. Hatipoglu recommends working with your doctor to come up with an individualized exercise plan, which should include walking and light weight training to help with balance.

Falls and Fractures

The risk of falls and fractures is a normal part of aging, but mobility problems associated with diabetes raise the risk even higher.

Hypoglycemia, or low blood glucose, can cause symptoms including shakiness, weakness, and lack of coordination. Hyperglycemia, or high blood sugar, can cause dehydration, leg cramps, and imbalance.

Hatipoglu stresses the importance of a safe home environment complete with non-slip rugs, bed rails, and grab-bars in the shower and bathroom.

Vision and Hearing

People living with diabetes have a much higher risk of eye complications, including glaucoma and cataracts, and the risk increases with age. Retinopathy, a disorder of the retina, is also common.

There are treatment options available, but the condition needs to be caught as early as possible. “It’s very important for elderly diabetics to have regular checkups with their ophthalmologist, especially if they are driving or working,” Hatipoglu said.

Hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. The reason for the increased risk is unclear, though it may be that diabetes damages nerves and blood vessels of the inner ear. If you suspect hearing loss, talk to your doctor.

Mental Health

“The lifestyle modification that comes with type 2 diabetes has definite psychological effects,” said Xavier Jimenez, MD, a psychiatrist at the Cleveland Clinic. The stress of diabetes management can take its toll on a patient’s mental and emotional well-being. Studies show that people with diabetes have a much greater risk of depression, which can compromise their self-care and commitment to a healthy lifestyle.

Even patients who have been dealing with diabetes for a long time can become demoralized. “It’s basically people saying they’re sick and tired of being sick and tired,” said Dr. Jimenez. “It’s a little less severe than depression, but should still be addressed.”

Diabetics may feel isolated from family and friends. Penceal emphasizes the importance of having a stable support system to help with the day-to-day challenges. “Find a group of people who are going through the same things you are,” he said. “It can be difficult when your family doesn’t have to go through the same diet and lifestyle changes you do. Join a support group to discuss those challenges.”

Diabetes, especially type 2, may increase a person’s risk for Alzheimer’s disease or vascular dementia. Evidence suggests diabetes may lead to mild cognitive and memory problems that impact a patient’s ability to manage their condition.

“If a patient keeps coming back with uncontrolled high blood sugar, instead of blaming them, we should sit back and ask ourselves, ‘Could this be a sign of depression or dementia?’ ” said Hatipoglu.

Bladder and Bowel Dysfunction

Diabetic neuropathies are disorders that damage nerves all over the body. When the autonomic nervous system — which controls the bladder, stomach, and intestines — is affected, patients may experience problems with bladder and bowel function. Symptoms can include constipation, diarrhea, urinary tract infections, and incontinence.

“When you have urinary incontinence, you are at a much higher risk for infection and as a result hyperglycemia, which can cause more urinary leakage,” said Hatipoglu. “It’s a vicious cycle.”

Hatipoglu urges patients to not be embarrassed. Report any changes in digestion and urination to your healthcare provider because early treatment is so important.

Drug Interactions

Older adults with diabetes may be taking several medications to manage multiple conditions, raising the risk for adverse interactions and side effects. Patients can become confused about dosages and what drugs are taken when.

The doctor should review all medications a patient is taking, even over-the counter drugs, at every visit. Hatipoglu suggests caregivers can help as well by writing down clear, easy-to-follow instructions.

“Writing down which medications to take and when in big letters is very helpful,” she said. “You have to get creative and simplify things so they can follow the instructions.”

Last Updated: 05/20/2014