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Diabetes Management in the Elderly

Part 2 of Aging Gracefully with Diabetes

For Dr. Fernando, there are four aspects in the treatment of elderly diabetics: medication, proper diet, exercise and stress. According to him, it is very important that patients comply with their medication and that physicians should closely monitor medication adjustments for their patients. On proper diet, he acknowledges the important role that family members play in ensuring that diabetes patients get the right nutrition everyday. He also recommends seeking the help of a dietitian or a diabetes educator for proper meal planning. Dr. Fernando likewise swears on the power of exercise or regular physical activity in diabetes management.And lastly, he gives value to removing stress in our system as it could increase blood sugar levels.

Meanwhile, Dr. dela Vega believes that treatment goals for the elderly with diabetes should be less strict. “Based on the American Geriatrics Society guidelines,for persons age 65 and older, the HbA 1 C goal is less than or equal to seven percent if the older person is still of good functional practice.”This cefers to a patient who is relatively independent, has an active lifestyle, and is able to take care of himself. “But if the patient is already frail with multiple medical problems and has difficulty taking care of himself, then the HbA 1 C target is now less than or equal to eight percent, which is less stringent,” says Dr. delaVega. She explains that this is because intensive glycemic control may lead to malnutrition and hypoglycemia. Dr.Yu-Gan agrees that the elderly are more prone to develop hypoglycemia, and says that this is why they are more cautious with giving them medications. “The reason why they tend to develop more hypoglycemia is because sometimes their appetite is not that good as before so they might not eat after taking their medications,” she explains.

Lifestyle modifications like weight management through proper diet and exercise may be easier for adults with diabetes, but may already be quite difficult for the elderly. Restricting diet in the elderly may lead to hypoglycemia; while the decline in physical abilities may make exercise difficult for them. “In the elderly you might not expect them to be as active as the younger population. They might also have joint pains that would make it difficult for them to exercise or even to walk:’ Dr. Yu-Gan says.

Other conditions in the elderly like hypertension and other heart conditions also increase the challenge of treating diabetes in older persons.The presence of these co-existing conditions in the elderly also means taking various medications which increase the risk for adverse drug reactions. Sometimes, decreased physical and/or mental capabilities may also make it more difficult for an elderly to follow treatment regimens. Dr. Yu-Gan adds that frequent monitoring of elderly patients for complications is very important. “We should be aware that these complications might be present in these patients already.”

Part 3: Getting out of harm’s way

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