Care & Treatment
Older adults with diabetes need the following assessments.
Your healthcare professional will take a thorough medical history and exam because of risks for other conditions. These include heart disease, circulatory problems, high blood pressure, high cholesterol, and liver disease. Some of these conditions can affect control of blood glucose levels. Also, some people with diabetes may need to see specialists, like ophthalmologists (eye doctors), dentists, and podiatrists (foot doctors).
Your healthcare provider will also need to do a thorough medication review. Some medications can cause glucose blood levels to rise. These medicines include glucocorticoids (a type of steroid), some heart drugs, and thiazides (a type of diuretic or water pill).
The healthcare provider will be looking for interactions, duplications, and side effects. Make a list of everything you’ve ever taken. Be sure to include all prescriptions, over-the-counter medications, vitamins, herbal and other supplements.
This is an assessment of geriatric syndromes, which are common health problems in older adults that aren’t a specific disease. Older adults are at higher risk for these syndromes. Assessments that can be helpful include:
- A functional assessment that will identify whether or how a person can increase physical activity.
- A cognitive and depression assessment that will identify whether a person can self-manage diabetes and what kinds of supports they may need to do this. For example, a family member may need to help the older adult with management.
Personal Health Goals
After these assessments, the healthcare provider will work with the older adult and any caregivers to set up health goals that the adult wants to achieve. For example, a person may have a short life span and inability to self-manage diabetes. In this case, tight glucose control may cause harm if blood glucose levels are too low and self-management causes distress.
Your healthcare professional may first recommend lifestyle changes to manage diabetes and prevent related problems. This will depend on other factors such as age and other diseases. These changes can include changes in diet to control blood sugar levels, losing a small amount of weight, and exercise.
If lifestyle changes don’t control your type 2 diabetes, medication can help lower your blood sugar.
This medication is used to help your body better handle insulin to control blood sugar levels. If Metformin doesn’t work the healthcare provider may prescribe:
- A combination of Metformin and another drug
- Insulin with or without Metformin
For each type of medication, side effects and monitoring of them varies with the person’s diseases, medications, and age. Each person’s target A1c levels and types of monitoring will be different.
The approach to glucose control also varies by where the older adult is. For example, in hospital, nursing home, or home care. Control that is too tight can cause dangerous hypoglycemia. Your healthcare provider needs to be very careful in helping you manage your diabetes.
Many medications are available to treat diabetes, and this list has expanded significantly over the past few years. Most of them are oral medications (pills), but some are shots. Each medication has advantages and possible side effects. Depending on the medication, side effects may include upset stomach, liver damage, heart failure, or weight loss.
Your healthcare provider will talk with you or your family or other caregivers about which medication or combination of them is right for you. Your pharmacist is also a good source of information about any medications you are taking.
If diet, exercise, and non-insulin medications don’t control your blood glucose level, your healthcare professional may suggest insulin treatment. Insulin may also be the first choice of treatment if your blood glucose levels are very high. There are many types and combinations of insulin.
You and each of your healthcare providers need to know about all the medications you’re taking to avoid problems, including any vitamins, herbs, over-the-counter medicines, or other dietary supplements you take. You need to know:
- Why you are taking each medication
- How and when to take them
- Common side effects
You also need to:
- Keep a list of all medications with you for emergency purposes, especially in the case of a medical emergency.
- Bring your actual medications with you when you see your healthcare provider so they can be sure the directions on the bottles are up to date.
- Fill all your prescriptions at the same pharmacy, if possible. Your pharmacist can alert you if the medications you are prescribed could interact with each other.
- Read the information that comes with your medications. Ask your healthcare provider or pharmacist if you have questions.
Monitoring your Glucose Levels
If a person takes non-insulin medications for diabetes, they probably do not need to monitor blood glucose every day. An A1c test every three to six months may be all that is needed to monitor diabetes control.
If a person takes insulin, their healthcare provider may want them to check blood glucose at least once a day. This helps the person adjust their insulin levels as needed. The two types of measurement are:
- A blood glucose monitor, or glucometer. This lets you check your blood glucose level. The provider may also recommend writing down the results and bringing them to appointments.
- A continuous glucose monitoring (CGM) device. A patch, like a sticker attaches to the skin and a small monitor is placed against it to obtain the glucose reading. CGM requires some skill to access glucose readings. The CGM may not be affordable depending on the person’s insurance coverage.
Hemoglobin A1c Level
Everyone with diabetes needs to work with their healthcare provider to decide what level of A1c will be best for them. Treatment and management depends on:
- Functional and cognitive status
- Other health conditions
- Life expectancy
Improving glucose control from poor to fair would be a large improvement in a person’s health.
Special Considerations for Glucose Control in Older Adults
The American Board of Internal Medicine has a program called “Choosing Wisely.” The program is designed to avoid healthcare services that are harmful or not needed. Choosing Wisely recommends:
- Avoiding use of medications to take hemoglobin A1c below 7.5% in most adults age 65 and older because moderate control is generally better.
- Using medications to achieve tight glycemic control in most older adults with type 2 diabetes not beneficial. Tight control leads to dangerous hypoglycemia (low blood glucose levels)in older adults. Reasonable glucose control targets would be:
- 7%–7.5% in healthy older adults with long life expectancy,
- 7.5%– 8% in those with a moderate number of other health conditions and a life expectancy of less than 10 years
- 8%–9% in older adults with multiple health conditions and a shorter life expectancy.
Last Updated April 2023
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