Ask the Geriatrician: Managing Diabetes in Older Adults

Ask the Expert - Managing Diabetes: Moreno and Mangione

Gerardo Moreno, MD
David Geffen School of Medicine, UCLA

Carol Mangione, MD, MS
David Geffen School of Medicine, UCLA

Q:   What is diabetes?

A:   When your body digests food it converts much of it into glucose, which is a kind of sugar that your cells use for energy. Your body also produces a hormone called insulin. Insulin helps you get the right amount of glucose in your bloodstream, which carries it to your cells. When something goes wrong with these processes, the result is diabetes.

Diabetes develops when the amount of sugar in your blood becomes too high, because your body doesn’t make enough insulin (type 1 diabetes), because your body doesn’t respond to insulin (type 2 diabetes), or both. The extra sugar that builds up damages your body parts. People with type 1 usually develop diabetes in childhood or as teenagers.   Older people are particularly likely to develop type 2 diabetes because your body’s ability to manage sugar declines with age. Being overweight is also associated with developing diabetes.

Q:   What is different for older adults with diabetes compared to younger people?

A:   Having diabetes increases the chance of having heart attacks, strokes, kidney or eye problems, which makes it an especially challenging disease for older adults to manage.  If you have diabetes, chances are your healthcare provider is also treating you for other problems, such as high blood pressure or high cholesterol. And that means you could be taking several different medications, and need to be followed carefully to make sure that all these medications are working safely together.

Older people with diabetes also may have trouble with depression, memory loss, urinary incontinence, falls, poor vision, and persistent pain. The good news is that all of these problems can be treated by your healthcare provider, so be sure to talk to them about it.   

Q:   What is glycemic control?

A:   Control of blood sugar is important in preventing or delaying problems from diabetes. Blood glucose levels can be checked to make sure that control is achieved. Everyone with diabetes needs their blood sugar checked. Your healthcare provider will do this using two tests. One is the hemoglobin A1C test, which lets you know how good your sugar control has been over the past 3 months. Everyone with diabetes needs at least two of these tests a year. The second test measures your blood sugar level before eating; this is called the fasting blood sugar or glucose test. Your healthcare provider will help you set a safe goal for your blood sugar control. 

Once in a while people with type 2 diabetes may need to test their blood sugar at home. Your healthcare provider can help you decide whether you need to do this and how often. 

Q:   What should my hemoglobin A1C level be?

A:   No matter what your age or general health is, everyone with diabetes needs to work with their healthcare provider to decide what level of A1C will be best for their long-term health. Your treatment and management will depend on how long you have had diabetes, what other conditions you have, and your life expectancy. You should talk to your healthcare provider about what target is right for you. 

Generally:

  • If you are a middle-aged adult and otherwise healthy and active, your healthcare provider will want you to aim for an A1C of 7% or less. 
  • If you are older and have a lot of medical problems, it is likely that an A1C between 7 and 8% would be very safe for you. It takes 10 to19 years before the benefits of an A1C lower than 7% is seen, and so generally moderate control is generally better for older adults

Q:   What can I do to control my diabetes?

A:   There is a lot that you can do every day to help your diabetes stay in control, including: 

  • losing weight if you are overweight
  • taking your medication correctly every day
  • eating smaller portions
  • making healthier choices by eating more vegetables, fiber, fresh fruits and eating fewer sweets and high-fat foods. 

Exercise is very important for people with diabetes. Even moderate exercise, such as walking, can help lower your blood sugar. If you also have high blood pressure, walking also helps to lower it. Exercise also decreases the risk of heart disease and helps mild depression. Because of differences in the physical condition of older diabetics, you should talk to your healthcare provider or diabetes educator to plan an exercise program that is right for you. 

If you are a smoker, quitting is the most important thing you can do to control your diabetes and improve your health.

 

Last Updated February 2013