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Diabetes is a common, yet serious chronic disease. It is becoming even more common, especially among older adults. About 16 million Americans have diabetes, half of these people are older than 60. It is estimated that 13% of people over the age of 70 have been diagnosed with diabetes. Unfortunately, about 11% of people between 60 and 74 years of age have diabetes but do not know it.

What is Diabetes?
Diabetes (also called diabetes mellitus) is diagnosed when the body's blood glucose (a type of sugar) is too high. Diabetes develops when the body fails to make enough insulin (a hormone that is important in controlling the body's glucose level) or fails to appropriately use insulin. Symptoms of diabetes and high glucose levels include weight loss, excessive hunger and thirst, lack of energy, frequent urination, feeling tired, vision problems, and confusion. In older adults a complication of diabetes can be the first sign of the disease, for example, an ulcer on the foot that is slow to heal.

If not controlled, diabetes can damage many parts of the body. It may even be life threatening. Heart disease, vision problems and kidney disease are more common in persons with diabetes. Older adults with diabetes may have more problems with falls, urinary incontinence (leaking bladder) and mood disorders.

Type 1 diabetes usually occurs in children and adults under 30 years of age. People with Type 1 diabetes must take insulin and control their diet and weight.

Type 2 diabetes is much more common than Type 1. It usually affects people over 40 years of age. This type of diabetes can often be managed in the early stages by losing weight, exercising and eating a low-calorie, balanced diet. Some people with Type 2 diabetes also take an oral medication, and some must take insulin shots.

Who Develops Diabetes?
A family history, obesity, and lack of exercise are risk factors for Type 2 diabetes. Some ethnic groups are also at higher risk of developing Type 2 diabetes (African Americans, Latinos, Hispanics, and American Indians, for example).

What can you do?
If you are at risk for developing diabetes, certain lifestyle changes might prevent or delay the development of the disease. This brochure outlines many of those changes.

If you have been diagnosed with diabetes, certain lifestyle changes can help you control the condition. They can also decrease your risk for complications. Living with diabetes involves working with your healthcare team to monitor and manage your blood glucose levels, along with making important changes in your lifestyle.

Diet and Nutrition
Persons at risk for developing Type 2 diabetes can delay the onset of this disease by controlling their weight with a balanced, low-calorie diet and by exercising regularly. For persons with diabetes, a balanced, low-calorie diet is important in managing the condition. Your health care provider, physician specialist, diabetes educator or dietician can help you plan a diet that takes into account your weight and level of activity. There are many resources available to help with meal planning.

Exercise
Exercise is good for everyone. It is especially important for people with diabetes or at risk for developing diabetes. Moderate exercise, such as walking, can help lower your blood glucose. Exercise also decreases the risk of heart disease, which is common in older people and in people with diabetes.

Physical condition, the severity of an older person?s diabetes, and the possibility of additional medical problems (such as high blood pressure or arthritis) play a role in choosing the right exercise program. Talk to your health care provider, or diabetes educator to plan an exercise program that is right (and safe) for you.

Although exercise helps control your blood glucose, your blood glucose level can become too low after exercising. Your health care provider or diabetes educator can tell you about blood glucose levels before and after exercise that are safe for you.

Smoking
People with diabetes who smoke are at much higher risk for several life-threatening conditions. Smoking makes even slightly high cholesterol levels more dangerous, especially for diabetics, it increases the risk of heart attack. Diabetic patients who smoke are three times more likely to die of heart disease as diabetic patients who do not smoke. People with diabetes who smoke are also more likely to suffer blood vessel disease, nerve damage, and kidney disease.

It is very difficult to quit smoking. Nicotine is addictive and smokers can also become dependent on the habit of smoking itself.

Your health care provider, or diabetes educator will be able to recommend ways to help you quit smoking. Nicotine patches, other medications and counseling are among the many resources available.

Glucose Control
Diet, nutrition and exercise are all ways to keep your blood glucose in control. Some people must also take insulin or an oral medication.

Your health care provider will perform a simple blood test called hemoglobin A1C on a regular schedule. Based on your condition, it may be done once a year or every few months. This test shows the amount of glucose in your blood over the last 2 to 3 months. It will help your health care provider determine if your diet, exercise and medication program is effective.

People with Type 1 diabetes taking insulin must monitor their blood glucose themselves by testing a small drop of blood with a test kit. Older adults with Type 2 diabetes who take insulin or oral antidiabetic medication may also need to self-monitor their blood glucose levels. Your health care provider, or diabetes educator will teach you how and when to monitor your blood glucose.

Learn All You Can About Diabetes
Research studies suggest that people with diabetes have a higher risk of having heart attacks. It is important that persons with diabetes also have their cholesterol level checked. For people in whom diet and exercise do not lower cholesterol, adding a cholesterol-lowering medication might be necessary.

Research has also shown that maintaining a normal blood pressure helps avoid complications.

Your health care provider can provide you with information about diabetes, glucose control, diet, and exercise. You can also ask your health care provider to refer you to a diabetes educator, a specialty physician, or to a diabetes management program. Annual diabetes self-management training is covered under Medicare Part B.

There are also many organizations and programs that provide free information to help you take care of your diabetes.

Additional Resources


1. The National Institute on Aging, "Exercise: A Guide From the National Institute on Aging," is a free guide, Call1-800-222-2225 or visit www.nia.nih.gov.

2. American Diabetes Association. Call 1-800-232-3472 or visit www.diabetes.org