Diabetes and the elderly: Staying on top of treatment
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Diabetes is a long-term, chronic disease that affects more than 37 million Americans, according to the Centers for Disease Prevention and Control. It occurs when the body doesn’t maintain blood sugar (glucose) at normal levels.
Left untreated, diabetes can lead to heart disease, vision loss, kidney failure and lower limb amputation.
About 95% of individuals with diabetes have type 2, which can develop later in life, more often is weight-related, and can lead to serious complications in elderly patients.
“Although it presents about the same as it does in younger patients, complications can be more severe because elderly patients don’t respond or react as quickly,” says Dr. Tamara Fogarty, MD, FACP, an internal medicine specialist with Edinger Medical Group. “If they take too much medication and have low blood sugar, that can be very serious.”
Adding to that, risks such as cardiovascular disease, heart attack and stroke are compounded with age, making diabetes a more serious condition for elderly patients. “We watch our senior population a lot more closely because of issues of both high and low blood sugar,” she says.
Seniors may have arthritis or mobility challenges, making it difficult for them to exercise. Maintaining a healthy diet can be challenging, too, Dr. Fogarty says.
“Senior patients living alone may not be able to make good choices, may not be able to get to the store or to prepare the food,” she says. “As basic as diet and exercise seem to be, they’re not with the senior population.”
Who’s at risk?
Type 2 diabetes can affect both older and younger patients and can be related to several factors, including weight, lifestyle changes or family history. Genetics can play a part, Dr. Fogarty explains, “but it’s one of those things I’ve incidentally seen. For example, it may occur every other generation. So, knowing that, you should try to optimize your diet or your exercise and visit your doctor regularly.”
Diabetes is most often diagnosed during a patient’s annual physical, says Dr. Fogarty, who has been with Edinger for 27 years and welcomes new patients.
“I see patients, hopefully, at least once a year, and I order a full array of routine labs, and one of those includes blood sugar,” she says. For patients who consistently have had a blood sugar level over 100, she will add a hemoglobin a1c test to the patient’s labs, which gives her the patient’s average daily blood sugar over the previous six weeks.
A reading between 5.7 and 6.4 is called prediabetes. Those patients are cautioned to be aware of their food choices and to exercise regularly, which helps decrease sugar as well, she says.
When hemoglobin a1c is greater than 6.5, patients run into the diabetic realm, she says.
Symptoms of diabetes
Diabetes is most often detected with a blood test before a patient will exhibit symptoms, Dr. Fogarty says. “If someone comes to me with symptoms, at that point it can be really bad. It means they probably haven’t seen a doctor for years.”
Signs of diabetes can include polydipsia – excess thirst; polyphagia – excess hunger; and polyuria – frequent urination.
“If somebody comes in and says they’ve been urinating two to three times a night, I’ll get a urine sample,” she says.
The normal blood glucose range in healthy individuals is between 70 and 125 milligrams per deciliter. If the urine sample shows sugar in it and their reading is from 1 plus to 4 plus, the patient is spilling at least 200 milligrams per deciliter or higher, Dr. Fogarty says.
“That’s when it breaks the threshold and shows up in the urine.”
Diet and exercise is crucial
A patient’s hemoglobin A1C level can dictate where to start with treatment, Dr. Fogarty says. If they score in the mid to upper 6s but less than 7, she advises the patient to minimize or eliminate foods high in carbohydrates such as bread, rice, pasta and potatoes and to choose fruits and vegetables that have a lower sugar content.
“Not all fruits and vegetables are created equal,” she explains. “Bananas and melons have a high sugar content, as do carrots and beets.”
She notes the South Beach Diet has a glycemic index in the back of the book that shows the difference between high glycemic and low glycemic fruits and vegetables, which can be helpful in restaurants or when grocery shopping.
“You think if you’re eating fresh foods, it’s all good,” she notes. “But it may not be the best choice if you have diabetes or high sugar.”
The ideal situation is when patients can control their diabetes with diet and exercise versus taking medication, Dr. Fogarty says. She emphasizes the importance regular exercise plays in lowering a patient’s blood sugar.
“Even if you don’t lose a pound, it also brings down blood pressure,” she says. “We like our diabetic patients to take a brisk, 20-minute walk at least three times a week.”
For seniors with mobility challenges, chair exercises can help. “We don’t want them to be sedentary, so if we can get them moving, that’s a good thing.”
The Edinger advantage
Edinger’s senior patients and their loved ones can breathe easier knowing Edinger has a dedicated staff of diabetes care coordinators who closely monitor their diabetic patients. Patients are assigned a specific coordinator whom they know they can call at any time. This personalized care means ensuring patients are up to date on their prescription refills, vision checks and doctor visits.
It’s a vital part of why Edinger Medical Group was named No. 1 medical group in California in diabetic care by the Integrated Healthcare Association (IHA) for 2020-2021, Dr. Fogarty says.
“The complications of diabetes make it a tough condition to try to control, especially in elderly patients, she says. “Edinger is better than other groups because we have the resources to be able to monitor patients, to keep an eye on them. The diabetic care coordinators communicate with the physicians and we discuss what we need to do. They’re very on top of everything.”
Family members can help, too, by checking in on their loved one at least once a week, shopping for them or cooking them healthy foods, and making sure they visit their doctor regularly.
“If patients have supportive family members or friends, that makes a huge difference compared to those who are isolated or on their own,” Dr. Fogarty says.
For more information about Edinger Medical Group or to schedule an appointment, call 714-965-2500 or visit edingermedicalgroup.com.