Diabetes at later age: a different focus needed

Anyone who has had diabetes for many years knows that there is a need to manage blood glucose (blood sugar) levels – especially avoiding them being high enough over many years to cause possible damage to your heart, nerves and other body organs.
 
But, keeping them from getting into that high range sometimes means they will fall too low - into what is called “hypo” (hypoglycaemia) range.
 
When this happens, symptoms including dizziness, loss of balance and loss of consciousness can occur and these become increasingly dangerous as you age.
 
A fall as a result of a hypo can cause a fracture or head injury with potentially irreversible impacts on your ability to live the life ahead as you had hoped.
 
So, as you age the focus of your blood glucose management needs to change.
 
In younger people, its high levels that are most damaging; as you get older it’s the low ones.
 
It is vital that you and your doctors and diabetes management team have ongoing discussions as you age to deteremine what you need.
 
The most recent guidelines for older adults advise maintaining a range of 6 – 15 mmmol/l (while for younger people that is usually 4 – 10 mmol/l).
 
Setting the lowest level a bit higher greatly reduces hypo and falls risk, but means your upper levels will often be higher than you would have liked in earlier years.
 
However, the risks associated with levels of 12, 13 or 14mmoll/l occasionally when you are 80 are not the same as when you were 30 or 40.
 
But there is one thing that doesn’t change at all no matter your age: your muscles help reduce the levels of glucose in your blood so hold the power to support your diabetes control.
 
The same applies whether you have had diabetes for decades, or have encountered it as type 2 or insulin resistance only in later years: maintaining your body muscle reserve and staying physically active is always the key in diabetes as it is in maintaining physical and cognitive capacity more generally as you age.
 
As far as eating goes, older adults need a bit more, not less, protein in their meals than younger adults and weight loss in old age, without very good resistance exercise as an integral part of a plan will cause some muscle loss so doesn’t have the value it once did.
 
There are 3 main things to remember as you advance into old age with diabetes:
  • Stay physically active and avoid dieting to lose weight because that will cause loss of body muscle.
  • Eat a good protein food at every meal to ensure your muscles have the resources they need to be there for your diabetes management and more.
  • Keep rethinking your management as the years progress.
 
- Ngaire Hobbins, Accredited Practising Dietitian
 
Ngaire is a dietitian and author of three books on nutrition, ageing and brain health presenting the science in this area in everyday language.
 
 
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