One of the most prominent health care concerns today is the rise of diabetes to almost epidemic proportions among the general population. Within the scope of such a broad health issue is the corresponding increase in Type II diabetes among senior citizens. In response, health care providers have become more acutely aware of the need for screening, early detection, and education.
Challenging an Aging Population
By Mike Haskew
Two Types of Diabetes
Type II diabetes, which has also been referred to as adult-onset or non-insulin dependent diabetes, is differentiated from Type I (also commonly referred to as juvenile diabetes) in that it is most often associated with insulin resistance, reduced insulin sensitivity, and reduced insulin secretion by the pancreas.
In contrast, Type I is characterized by the loss of beta cells of the islets of Langerhans within the pancreas, which actually produce insulin. The ability of cells to utilize insulin, a hormone which regulates the absorption of sugar from the bloodstream, actually fuels the body.
The Increasing Rate of Cases
In 2007, the Centers for Disease Control (CDC) reported that approximately 23 percent of the U.S. population over the age of 60, nearly 12.2 million people, has diabetes. The CDC estimates of annual diagnoses of diabetes easily exceed 500,000. Almost 24 million Americans live with diabetes, and from 2005 to 2007, the rate of increase among the population was a startling 15 percent.
As for seniors, another study revealed that during the decade from 1994-2004 diagnosed cases of diabetes increased 23 percent among those over 65 years of age and the overall prevalence of the disease was up 62 percent.
Common Causes, Symptoms, and Concerns
The effects of normal aging become factors in the development of Type II diabetes among seniors, and often other detrimental health conditions may develop or be exacerbated as a result. “Factors that lead to worsening insulin resistance include aging, gaining weight, and being sedentary,” reports the Geriatric Times. “Since the population is aging, it is not surprising that the elderly increasingly comprise a larger proportion of patients with newly diagnosed diabetes. In 1993, 43% of the approximately 7.8 million people diagnosed with diabetes [in the U.S.] were over 65 years of age.”
The complications associated with Type II diabetes are potentially fatal; however, the disease itself is often very difficult to diagnose due to the fact that its symptoms are often subtle in nature. Individuals do frequently live with Type II diabetes for years without knowing they have the condition or seeking treatment. The classic symptoms of the disease include the following:
• Frequent infections or slowly healing wounds
• Fatigue due to the deprivation of energy from cells
• Weight loss due to the depletion of fat and muscle tissue even though the individual may be hungry constantly and eat more
• Blurred vision due to high blood sugar levels depleting fluids in the eyes
• Increased thirst due to the need to replenish fluids drawn from body tissues
• Frequent urination as a result of greater fluid intake due to thirst
• Extreme hunger due to organs and muscles requiring more energy because they cannot metabolize sugar efficiently
“Age is a risk factor for diabetes in and of itself,” explains Rosemary Ertel, Director of the Diabetes and Nutrition Center at Memorial Hospital. “Just being over the age of 45 puts you at a higher risk. That along with a lack of exercise and improper diet can put a person at greater risk.
“In Type II,” Ertel continues, “you almost have two types of patients. These include those individuals who are aged 40-50 and are usually overweight and inactive with a strong family history of diabetes. This group is called insulin resistant, which means that their bodies make insulin but don’t use it get the sugar into the cells where it can be burned. The second group is a little older, usually in their 60s, and they are not necessarily overweight but their bodies over time are not producing as much insulin as they need. So, the lack of insulin causes their blood sugar to rise.”
According to the Mayo Clinic, the complications of untreated Type II diabetes may be extremely harmful. These include:
• Heart and Blood Vessel Disease: Diabetes dramatically increases coronary artery ailments with chest pain, the incidence of heart attack, stroke, narrowing of the arteries, and high blood pressure.
• Nerve Damage: Excess blood sugar levels may damage the walls of small blood vessels in the extremities, causing tingling, numbness, burning, or pain in the toes or fingers and gradually spreading over time. In men, erectile dyfunction may result. Damage to other nerves may cause diarrhea, constipation, or nausea.
• Kidney Damage: If the tiny blood vessels in the kidneys, which filter waste from the bloodstream are damaged, kidney function is diminished or kidney failure may occur, resulting in the need for a kidney transplant or dialysis.
• Foot Damage: Poor circulation due to damaged blood vessels in the feet may cause complications with cuts or blisters that result in infections and ultimately amputations.
• Eye Damage: If the blood vessels that supply the retina are damaged, diabetic retinopathy may lead to blindness. Other conditions such as glaucoma and cataracts may also develop.
• Osteoporosis: Lower bone density could result from diabetes.
• Skin and Mouth Conditions: Bacterial or fungal infections may develop, along with itching, due to diabetes. Gum disease is also more prevalent.
• Alzheimer’s Disease: Some studies indicate that diabetes may increase the risk of this disease due to inhibited blood flow to the brain or higher levels of insulin in the blood causing damage to brain cells.
The CDC reports that in 2004 heart disease was a contributing factor in 68 percent of the deaths of individuals 65 or older, while stroke contributed to 16 percent of diabetes-related deaths in the same age group. The agency also announced that people over 60 with diabetes “are two to three times more likely to report an inability to walk one-quarter of a mile, climb stairs, do housework, or use a mobility aid compared with persons without diabetes in the same group.”
The American Heart Association recently noted that in 2007 the risk of stroke more than doubled in the first five years following the beginning of treatment for Type II diabetes and that about 75 percent of those who have diabetes will eventually die of some type of heart or blood vessel disease.
Lowering the Risk
In response to the growing need for diabetes management and education, the Diabetes and Nutrition Center at Memorial Hospital was established a decade ago. “We provide a lot of materials for people with diabetes, and our classes are taught by a registered nurse and a registered dietician,” relates Ertel. “All our instructors are certified diabetes educators, and we teach topics like diet, dealing with stress, exercise, and overall blood sugar management. We also answer questions such as how medications may affect blood sugar levels and how to use a meter to check blood sugar. We do have a class that is geared for the senior population and encourages seniors to bring a friend with them.”
A healthy lifestyle reduces an individual’s risk of developing diabetes and assists those with the condition in keeping it under control. The Mayo Clinic says:
• Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains.
• Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk walk daily. Ride your bike. Swim laps. If you can’t fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. If you’re overweight, losing even 10 pounds can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy, and improved self-esteem.
“Our diet classes are based on carbohydrate counting,” says Ertel. “We teach people how many carbs they can have in total per meal, and then it is up to them how they want to spend their carb allowance. We stress making sure they get adequate protein, healthy fats, and lower carbs. When we look at the senior population, some people in that age group have specialized needs such as vision difficulty, or they may need a certain type of meter that is easier to use. We instruct some of these patients who can’t get out and do a lot of activity about attending a cardiac rehab program at the hospital.”
Ertel also indicates that the number of seniors with pre-diabetes, or elevated blood sugar levels which are not high enough to be considered diabetes, is on the rise. “This is something new because doctors are trying to prevent those with blood sugars that are high from becoming diabetic,” she comments. “Statistics say that 58 percent of the population with pre-diabetes could prevent the onset of full diabetes with as little as 30 minutes a day of exercise and a proper diet. Years ago, we had nobody referred for pre-diabetes, so doctors are screening more among the senior population now. Now we have a pre-diabetes class twice a month, and we started it a couple of years ago because of the demand.”
Classes at the Memorial Diabetes and Nutrition Center are scheduled at various times on the Glenwood campus and in Hixson to accommodate those who work or prefer to attend at varied hours. A physician referral is required, and those interested in more information may call the center at (423) 495-7970 or visit online at www.memorial.org.
Living with diabetes may present challenges for seniors, but a better quality of life is indeed achievable.