“Aging starts from the womb and ends in the tomb,” says Dr. delaVega. She relates that most of the time, what they see in the geriatrics clinic are already complicated cases of diabetes.”We need to nurture even healthy mothers, healthy pregnancies so that the child that comes out from the womb is healthy and leads a healthy life all throughout his life, towards adulthood and later as an older person.” Weight control, diet, exercise and positive outlook are factors that appear to be beneficial for both diabetes and aging. As always, making some basic lifestyle changes can help the elderly manage the disease and reduce the risk for further complications.

Smoking for instance, should not be part of an elderly lifestyle. If you happen to be a smoker, quitting as soon as you get older can definitely help. Data from the American Geriatric Society showed that people with diabetes who smoke are three times more likely to die of heart disease than non-smokers. This is because smoking also increases a person’s risk for many other health conditions like hypertension, nerve damage and kidney disease. Along with smoking, alcohol consumption should also be greatly reduced if not totally stopped among the elderly. Too much drinking greatly affects blood sugar control.

Again, the importance of regular monitoring of one’s blood glucose everyday can not be overstressed. Everyone with diabetes should monitor their blood sugar at least once a day. If you cannot do it yourself, ask someone to do it for you. For older persons with diabetes, Dr. dela Vega has these to say: “Make sure that you heed your doctor’s advice and take whatever medications are prescribed. Keep your appointment with your doctor, especially since your doctor will be the one to monitor your blood sugar. If possible, get your own blood sugar monitoring kit at home because that is going to be really helpful. Again, healthy diet, regular exercise and vaccination against flu or pneumonia are very important:”

Dr. dela Vega adds that since older patients are more prone to infection and that flu and pneumonia can be worse in diabetes patients, then flu shots and pneumonia vaccine are vital. She adds that even anti-tetanus vaccines are important too since some diabetic patients may already have nerve problems and may not easily feel if they have wounds in their toes and feet. Untreated wounds increase one’s risk for tetanus.

The same lifestyle modifications will apply for a non-diabetic elderly to prevent the development of diabetes. “Watching their diet and maintaining good physical activity are still the cornerstone of prevention,” says Dr.Yu-Gan. “We all recommend healthy diet, eat a variety of fruits and vegetables, and limit caloric intake because studies have shown that caloric limitation improves life expectancy,” says Dr. dela Vega. She adds that partaking in healthy activities, exercising regularly, and screening of fasting blood sugar for early detection of diabetes are also very important.

To help care for the elderly, various diabetes organizations in the country have established their own programs to better manage diabetes in the said age group. According to Dr.Yu-Gan, the Philippine Diabetes Association has programs for all diabetic age groups. “I think for the elderly we focus more on complications. We have lay fora specifically for complications to make them aware of the possible complications that they face or may already have, and how to hdndle it,” she says.

For their part, the Philippine Society of Geriatric Medicine addresses general health issues regarding elderly care through their outreaches, lay fora and yearly medical convention where they tackle issues that would help improve geriatric care in the Philippines. Meanwhile the Institute for Studies on Diabetes Foundation (ISDF) has continuing training for diabetes educators. According to Dr. Fernando, ISDF teaches doctors to be more proficient in treating diabetes patients including the elderly. They also have ongoing researches to further improve diabetes care and treatment.

Dr. Fernando also shares that ISDF doctors have a service clinic every Saturday for diabetic patients. The service clinic attends to patients who need medical help, including indigent patients who cannot pay for a doctor. These patients flock to the ISDF building in Marikina where they are tested for their blood sugar and other parameters like cholesterol and triglycerides. ISDF also gives them appropriate medicines.

Finally, Dr. Fernando relates that in 1998, the Diabetes Commission has put in place the Philippine Diabetes Prevention Program (PDPP). The PDPP states that all municipal health offices in the Philippines should allot one day for all patients with diabetes. Under the PDPP, all health centers in the country should have equipment for monitoring blood sugar, blood pressure, including weighing scales, to monitor patients with diabetes. If only nationwide programs like the PDPP can be put in practice all over the country, it would greatly help the Filipino elderly diabetic to better manage their disease and prevent further complications. But for now, heeding the experts’ advice can go a long way to keeping diabetes under control and aging gracefully with diabetes.

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According to the data from the 2000 Census of Population and Housing, 4.6 million or 5.97 percent of Filipinos belong to the senior citizens group (60 years old and over). Advancing age, along with weight and genetics, is one of the risk factors for developing type 2 diabetes. All over the world, approximately eight percent of people over age 65 have diabetes. For the elderly with diabetes, aging can be as normal as for those without the disease. An elderly person can still live to the fullness of his being even with diabetes. One of the first steps in dealing with diabetes in old age is by understanding how diabetes affects the elderly.

Aging and diabetes
“Most diabetics are either in the middle age group or in the older age group,” says endocrinologist Dr. SusanYuGan, treasurer of the Philippine Diabetes Association (PDA). She explains that this is because as we grow older, the way our body handles sugar becomes more deficient, and that insulin production in
the pancreas and the uptake of glucose in the peripheral tissues become slower. These factors increase blood sugar as a person ages. Diagnosing diabetes in the elderly might be quite difficult because many elderly diabetics are asymptomatic, meaning they do not feel any symptoms at all. According to diabetologist Dr. Richard Elwyn Fernando of the Institute for Studies on Diabetes Foundation (ISDF), diabetes manifests slowly in the elderly, which is why no symptoms are felt in the beginning. In this case, Dr.YuGan says that screening, through blood sugar testing, is very important.

However, if an elderly has some of the so-called identifiable risk factors, then it will be easier to diagnose them. These so-called identifiable risk factors that include obesity, family history of diabetes, physical inactivity, and the presence of concomitant diseases like hypertension and cholesterol abnormality, increase a person’s risk of developing diabetes. Although some individuals may present with symptoms, doctors say it would still be difficult to identify symptoms as uniquely due to diabetes because some of these may be associated with aging. Frequent urination, for example, might be associated with prostate problems or dysfunctional bladder, explains Dr.Yu-Gan. Even vision problems may be thought of as just signs of aging, and thus, the person would not seek, or delay seeking medical attention.

Among the elderly, diabetes complications also tend to develop more quickly as a result of the long period before diagnosis. As such, older people may have more complications that may be more severe than in younger people. “Most of the time, unfortunately, when we get a diabetic in the later years, that’s the person who already has complications of diabetes,” said Dr. dela Vega, who is also head of the Center for Healthy Aging at The Medical City and chairperson of the Committee on Aging of the National Institutes of Health at the University of the Philippines in Manila.

According to Dr. dela Vega, a lot of elderly patients with diabetes seek medical help only when they already have other medical problems like painful extremities or diabetic nerve damage, abnormal digestion, vision problems and kidney disease. “Because diabetes prevalence increases as people age, we get more people with end-stage disease at this age group,” she says.

Part 2: Diabetes Management in the Elderly

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