One out of four adults aged 60 or older have type 2 diabetes, according to the American Diabetes Association. An early diagnosis is key to managing the disease, but that can be a challenge since many of the symptoms can be confused with other conditions that are common in the older population.
“Some of the signs and symptoms for type 2 diabetes may be initially overlooked in the older population because they may mimic other common problems associated with aging,” says Susan Weiner, MS, RDN, CDE, CDN, owner of Susan Weiner Nutrition PLLC and the AADE 2015 Diabetes Educator of the Year. One of the top diabetes nutrition education bloggers in the country, Weiner also is the author of two books: The Complete Diabetes Organizer: Your Guide to a Less Stressful and More Manageable Diabetes Life and Diabetes: 365 Tips for Living Well.
Signs of Type 2 Diabetes
Weiner reports that there are several signs of type 2 diabetes in adults, including: fatigue, dry mouth, excessive thirst, excessive urination, hunger and/or weight loss, blurry vision, difficulty in thinking clearly or concentrating, irritability and having wounds that don’t heal properly.
“If we look at these symptoms, starting with fatigue, seniors may be tired due to many factors associated with aging (including medication side effects, chronic disease or depression),” Weiner says. “Often it’s not recognized as a symptom of high blood glucose or type 2 diabetes.”
Weiner adds that older people often experience dry mouth as a side effect of various medications not related to type 2 diabetes. Similarly, such symptoms as excessive urination, difficulty in thinking, vision impairment or weight loss can occur in older people for reasons other than type 2 diabetes.
As they age, many seniors experience a reduced ability to perceive thirst to the point that they often don’t hydrate themselves to the extent that they should. “Therefore, if a senior suddenly becomes excessively thirsty, that might be a sign or symptom of type 2 diabetes,” Weiner says. “Also, if you’re experiencing excessive urination, don’t put that off as having less bladder control because you’re getting older. If it goes along with some of these other symptoms, you should discuss this with your doctor or healthcare provider.”
Many Cases Go Undiagnosed
Given the uncertainty associated with some of these symptoms, there are millions of people who have diabetes and don’t know it. “Among Americans who are 65 years of age or older, there are 11.8 million who have diagnosed and undiagnosed type 2 diabetes,” Weiner says. “As we continue to age as a population, those numbers are continuing to go up.”
Weiner observes that an even larger segment of the population has pre-diabetes, which if left undiagnosed and untreated will progress to type 2 diabetes. “Many times, we think that type 2 diabetes comes on suddenly, but if you haven’t been to your doctor or healthcare provider for a while, you may not be aware that your blood glucose levels are trending upward,” Weiner reports. “If you are aware that you have pre-diabetes, there may be steps you can take to possibly delay the onset of type 2 diabetes. If diagnosed early, you can manage your blood glucose levels and reduce your chances of developing complications associated with type 2 diabetes.”
Some individuals have a genetic predisposition to type 2 diabetes. “In that case, it can be very hard to prevent it, but you can properly manage it,” Weiner says. “The side effects of dealing with very high blood glucose levels in an older person can be devastating—literally loss of sight and limb. But the good news is that in many cases it can be delayed with healthy lifestyle changes and medication management.”
Better Food and Exercise for Seniors
Among the lifestyle changes that may help delay the onset of type 2 diabetes—and also slow its progression—are a nutritious diet, regular exercise and weight control. For those diagnosed with type 2 diabetes, the disease can be managed through medications. In some cases, that may be an oral medication, but in other cases an injectable medication may be required.
“Many elderly people with type 2 diabetes require insulin to manage their blood glucose levels,” Weiner says. “Treatment is very individualized, and in some cases patients may need to change medications as the disease progresses.”
Making sure that your parent eats a nutritious diet is very important to managing type 2 diabetes, Weiner stresses. “That means cutting back on junk food and limiting your intake of processed foods and processed carbohydrates. The preferred diet would include foods that are higher in lean protein, complex carbohydrates, healthy fats and fiber.”
However, Weiner cautions against becoming the “food police.” “That definitely will not end well. You can work in some of the foods your parents enjoy, but make sure it’s portion-controlled. It’s a bit of a challenge, but it’s certainly doable. It doesn’t have to be a perfect diet for controlling blood glucose, but you want to move in the right direction.”
Advice for Caregivers
For family members, caring for an elderly parent with type 2 diabetes can be challenging due to such issues as the irritability associated with the disease or other non-related health issues such as cognitive impairment.
“Cognitive function can absolutely be made worse by high blood glucose levels as can other issues such as visual impairment,” Weiner says. “So, imagine if that is the case and you can’t read your medication label properly due to visual or cognitive impairment. Your parent may also have a diabetic-related neuropathy that affects their lower extremities, which in addition to other issues related to aging, may impair mobility. It’s also possible for individuals to have diabetic nerve loss in their hands due to the higher blood glucose in this population, meaning they might touch something very hot like a stove, burn their hand and not even know it.”
Weiner adds that there could also be problems with polypharmacy, given that many individuals take multiple drugs to treat such conditions as heart disease and arthritis in addition to their type 2 diabetes. “That’s a big issue that can affect quality of life, so you may have to go over your parent’s medication with their pharmacist or healthcare provider to ensure that there isn’t a drug interaction problem from taking so many prescription as well as over-the-counter medications,” Weiner advises.
If family caregivers are being stretched to their limits by providing care to their aging parent with type 2 diabetes, it may be advisable to hire a home health aide who can come into the home to help with meal preparation and other care-related issues. Weiner also stresses the need for caregivers to seek education about the disease.
“I would recommend that the caregiver reach out to someone who is educated in type 2 diabetes such as a certified diabetes educator or geriatric specialist,” she says. “They can help you navigate through difficult issues and can recommend resources for you such as community or hospital-based support groups.”
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