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Diabetes mellitus is a chronic disease that affects many body systems. Older persons with diabetes are at increased risk for developing several serious complications, including blood flow (circulatory) problems, heart trouble, stroke and vision problems. They are also at greater risk for depression, cognitive (mental) impairment, urinary incontinence, and falls.

This brochure briefly explains these possible complications, and ways to help avoid them and their effects.

Hypertension (High blood pressure)
Hypertension is very common in people with diabetes. It is a serious disorder that can result in many serious medical problems. Like diabetes, hypertension cannot be cured - but it can be treated and managed.

Hypertension causes the lining of the arteries to become diseased. This condition can lead to heart attack and stroke and can affect blood flow, the kidneys, and the eyes. People with diabetes have a greater risk for developing these problems. Those with diabetes and hypertension have even higher risk of developing these serious complications.

Since hypertension usually has no symptoms, the only way to know you have it is to have your blood pressure checked.

Controlling blood pressure is just as important as controlling blood glucose levels. In fact, many of the same lifestyle changes that help control blood glucose work to control hypertension. These include keeping your weight at a healthy level, exercising, eating a healthy low-salt, low-fat diet, and not smoking. If lifestyle changes do not succeed in lowering the blood pressure to a safe level, medication(s) may be necessary.

Urinary Incontinence (Bladder leaking)
Urinary incontinence is a problem that affects about 13 million Americans. Increased thirst is a symptom of diabetes, which likely results in drinking more fluids. Drinking more fluids leads to having more urine.

At the same time diabetes can cause nerve damage that can keep the bladder from emptying. The bladder can then get very full, which can cause leaking. This is called overflow urinary incontinence. A person with diabetes may not feel a sensation of fullness.

People with diabetes may also have other types of urinary incontinence:
stress (leaking after laughing, coughing or sneezing)
urge (a sudden need to empty the bladder and often not making it to the bathroom in time)

Bladder infections, which are common in people with diabetes, can also lead to urinary incontinence. Bladder infections can usually be cured easily with medication.

You should tell your health care provider if you experience any symptoms of urinary incontinence. There are many treatments for urinary incontinence, so it is important to know the cause.

Emptying the bladder at specific times (bladder "training") and doing pelvic muscle exercises may be helpful for stress and urge incontinence. It is important to stop drinking liquids with caffeine such as coffee or soft drinks, to help reduce sudden urges to empty the bladder. There are also new medications that can help certain types of urinary incontinence.

Falls
The chances of falling and the severity of injuries from falling increase after the age of 60. Falling is a serious problem that can lead to being admitted to a hospital or nursing home. Falling is even more common among persons with diabetes.

There can be many reasons for falling. Some common causes of falls that can be fixed easily include poor lighting, rugs, smooth-soled shoes, and electrical cords. Among those older people with diabetes, falls can be caused by slower reflexes, vision problems, obesity, medications, and foot problems. Diabetic patients who have lost the sense of feeling in their feet are also at higher risk of falling. Taking certain medications or taking multiple medications (more than four) may also increase the risk of falling.

You should tell your health care provider if you have fallen. Your health care provider can help determine the cause and will help you decrease your chances of falling again.

Depression
The rate of depression among patients with diabetes is about double that of the general public. Living with diabetes can be demanding and stressful. For some, the lifestyle changes that are necessary to control diabetes may be difficult.

Depression can affect people differently, but for many, depression causes general feelings of sadness, helplessness, hopelessness, and/or despair that last more than two weeks. Depression can also cause a loss of energy, sleep problems, and a feeling of being overwhelmed.

Too often, health care providers do not see the signs and do not ask patients about feelings of depression. It is important to tell your health care provider if you feel depressed. There are many treatments for depression, including counseling, support groups, and medication. Treating depression will make it easier to manage your diabetes.

Cognitive (Mental) Impairment
Cognitive impairment means that the person's perception, memory, learning ability, verbal skills, and/or judgment are decreased. Older adults with diabetes are at greater risk for developing cognitive impairment.

Cognitive impairment can make managing diabetes difficult. Persons with cognitive impairment may not be able to monitor their blood glucose (sugar) or take their medications correctly, which can be very dangerous.

Your health care provider can screen for cognitive impairment by asking a few simple questions. Some of the causes of cognitive impairment can be corrected. Your health care provider will review all the medications you are taking (including any over-the-counter medications, vitamins, or herbal remedies) to determine whether medication(s) could be responsible.

Your health care provider can refer you and your caregiver(s) to a diabetes educator, a specialty physician in diabetes or geriatrics, or to a diabetes management program. These professionals can assist with managing diabetes in patients with cognitive impairment. Annual diabetes self-management training is covered under Medicare Part B.


Please visit the The AGS Foundation for Health in Aging for more in-depth information on any of these complications. Additional resources are available to learn more on falls, urinary Incontinence, depression, hypertension and cognitive impairment. Visit us online at www.healthinaging.org or call us as 1-800-563-4916 for more information.

Additional Resources


American Diabetes Association
ATTN: National Call Center
1701 North Beauregard Street
Alexandria, VA 22311
1-800-DIABETES (1-800-342-2383).
www.diabetes.org

The Centers for Disease Control and Prevention,
Publications and Products: The Prevention and Treatment of Complications of Diabetes Mellitus: A Guide for Primary Care Practitioners.
www.cdc.gov/diabetes/pubs/complications/

Complications of Diabetes
Columbia University College of Physicians & Surgeons Complete Home Medical Guide.
cpmcnet.columbia.edu/texts/guide/hmg21_0006.html