Diabetes is a dangerous disease accompanied by various complications that affect the cardiovascular, nervous, excretory, musculoskeletal systems of the body and the organs of vision. Diabetes is one of the main causes of blindness, kidney failure, heart attacks and strokes in the world. The situation does not improve over time. According to WHO forecasts, by 2030 this disease will rank seventh as the leading cause of death in the world’s population. However, diabetes can be lived with and treated. And if he is not completely cured, the complications associated with the disease can be reduced to almost zero. It depends, first of all, on the will of the patient, the competence of the doctor, as well as on the type of disease (first or second). Correct lifestyle, regular physical activity, absence of bad habits and excess weight greatly reduce the risk of diabetes.
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Predisposition to diabetes in older people. Causes
What is diabetes? A chronic disease characterized by high blood glucose levels. This is due to insufficient production of insulin (a hormone that regulates sugar concentration) by the pancreas or insulin insensitivity of the body tissues.
According to the World Health Organization, diabetes is one of the fastest growing diseases in the world. Compared to 1980, the incidence of diabetes has quadrupled. First of all, this applies to countries with low and middle income levels of the population. It is clear why: it is there that people cannot afford a correct and healthy diet. Their diet mainly consists of high-carbohydrate foods, with a lack of vegetables and proteins.
In old age (usually after 50 years), a decrease in sugar tolerance is natural, since the overall level of secretion and action of hormones decreases. Every ten years, the morning glucose concentration increases by approximately 0.055 mmol / L, and the sugar level increases by 0.4 mmol / L 2 hours after a meal. Of course, these figures are averaged, but the statistics clearly characterize the overall picture. Older people usually have type 2 diabetes or non-insulin dependent diabetes. The causes of this disease lie in physical inactivity and improper diet (or rather, the excess weight to which it leads). The fat “pocket” on the stomach is not a natural organ of the endocrine system. The so-called visceral or abdominal fat envelops the internal organs, protecting them and being an energy accumulator. But, if there is too much of it (more than 15% of the total volume of all fat cells), this negatively affects the state of the body, since viscera blocks the uninterrupted flow of blood and lymph, contributes to the formation of an oxygen imbalance, which manifests itself in the form of symptoms of heart failure (shortness of breath, nocturnal apnea, etc.). It cannot be removed surgically, it must be fought with a healthy lifestyle. This fat, when there is a lot of it, growing, penetrates into the organs, getting into their cells. It seeps into the blood vessels, gets deposited on the walls and narrows their lumen, which leads to hypertension.
Excess weight as a cause of diabetes
Insulin brings glucose into the cells. Visceral fat produces specific hormones that help the body’s tissues absorb sugar using insulin. When there is an excess of fat, too much hormones are produced, which leads to a loss of tissue sensitivity to insulin. That is, we eat, the concentration of glucose in the blood rises, there is also insulin, since the pancreas is working properly, but insulin cannot deliver glucose into the cells. This is called insulin resistance or loss of tissue sensitivity to insulin. The result is type 2 diabetes.
Now the so-called “adult” diabetes (type 2) is getting younger. Even children get sick with it. It is clear why this is happening. Malnutrition and inadequate activity are common already at a very young age. This is a very disturbing sign. Medical health organizations in all countries are now trying to maximize their work in this direction.
Diabetes mellitus after 60 years
Insulin resistance appears in people after 60 years, regardless of their lifestyle. It is not known for sure whether the degree of human activity affects the change in the tolerance of his body tissues to insulin or not. However, factors influencing the development of grade 2 diabetes in an elderly person have been identified. These include:
- Incorrect diet, i.e. high-calorie food with a large amount of easily digestible carbohydrates and fats, combined with a lack of proteins and complex carbohydrates;
- An inert lifestyle, physical inactivity – this leads to tissue resistance to insulin, since muscle volume decreases;
- Taking some diuretics from the thiazide group, beta-blockers for coronary heart disease and hypertension, some drugs for the treatment of mental disorders, as well as hormones from the group of glucocorticosteroids, since they all affect metabolism;
- A genetic predisposition in the form of an insufficient content of the glucosinase gene, which contributes to the recognition by the pancreas of simple carbohydrates entering the body, and in response to this, the production of insulin.
The earlier a person joins a healthy lifestyle, the lower the likelihood of developing type 2 diabetes in old age.
Features of the course of the disease in the elderly
With age, the sensitivity of the receptors in the brain dulls, so a person may not be aware of some of the symptoms characteristic of diabetes (itching, thirst, etc.). Without thirst, a person does not increase the amount of fluid consumed, which is very dangerous. This can lead to dehydration, an extreme degree of which is fraught with hyperosmolar diabetic coma. Its mortality rate ranges from 30 to 50%. Hypoglycemia is a condition characterized by sudden physical weakness, drowsiness, and forgetfulness. This is a situation when the blood sugar level drops sharply (this happens if the norms of the injected insulin or a glucose-lowering drug have been exceeded). In this case, it is urgent to measure the blood sugar level and give the patient something sweet (a spoonful of honey or sugar, candy, etc.).
Modern medicine offers several options for the approach to diabetes management and the reduction of its symptoms in old age. And one of the main ones is the transition to a low-carbohydrate diet (the so-called table D), where the consumption of animal fats is reduced, its substitutes are used instead of sugar (fructose, xylitol, etc.), from carbohydrates – only complex ones (vegetables, some cereals , black bread). Maintaining an active lifestyle, including walking and, if possible, physical therapy, is of great importance in the treatment of diabetes. The number and intensity of classes should correspond to the condition of an elderly diabetic. Why is physical activity so important for patients? The answer is simple:
- Working muscles promote better absorption of glucose from the blood;
- Light cardio loads improve the state of the cardiovascular system: lower blood pressure and inhibit the development of atherosclerosis.
Of course, the treatment of diabetes is not complete without the use of medications for the disease and its accompanying symptoms. First of all, these are various hypoglycemic drugs. With concomitant diseases, appropriate vasodilators, metabolic and antiplatelet agents are prescribed. Insulin therapy is carried out in case of previous surgical interventions, the presence of complications or ineffectiveness of the current treatment. In some cases, doctors recommend the use of herbal preparations (tinctures and decoctions of Jerusalem artichoke, bay leaf, ginseng). When there is a sharp drop in glucose levels, emergency care is needed. Although this condition is rare in older people. In order to avoid the development of coma, the patient should be quickly given simple carbohydrates (candy, a spoonful of sugar or honey). If a person has already fallen into a coma, inject a glucose solution intravenously.
Treating the elderly: diabetes medications
With such a serious pathology, it is impossible to do without medication treatment. This is especially true for elderly patients, in whom all processes in the body gradually slow down. The second type of diabetes has its own set of medicines.
On this substance, drugs such as Glucophage and Siofor were created. The latter requires a detailed examination of the kidneys, since it gives a significant load on them, and therefore, without diagnosis and doctor’s permission, it is deadly to take such a drug. Preparations on metmorphine must be combined with a low-carbohydrate diet and light physical activity like exercise therapy. These drugs have a positive effect on the body of the elderly (if there are no contraindications): they lower blood sugar without the risk of hypoglycemia, do not increase the patient’s weight. At the same time, there is no such wearing effect on the pancreas.
Sulfonylureas and Clays
Sometimes drugs of these groups can be prescribed, but for older people these types of compositions are undesirable. They force the pancreas to produce insulin, which is why the cells simply work for wear and tear. In this case, it is better to pay attention to insulin, which causes much less damage to the body of an elderly person than these medications. This group of drugs can provoke hypoglycemia if taken incorrectly, which often happens in older people. In addition, these funds simply “finish off” the pancreas, which quickly stops producing its own insulin. In parallel, there is usually an active weight gain.
Glitazones (also called thiazolidinediones)
The main representatives are Roglit, Aktos, Avandia and others. These medications help increase the sensitivity of cells to insulin. Accordingly, when they are taken, there is no great load on the pancreas. Their effectiveness is often compared with metmorphine, since in such a group of drugs the risks of hypoglycemia are not so high. On the other hand, the effectiveness of this drug directly depends on the fact whether insulin is produced by beta cells. In old age, with type 2 diabetes, these processes are often reduced or do not work at all. But the drugs also have their own contraindications, especially from the side of the heart with blood vessels.
These inhibitors, also known as GLP-1, are referred to as one of the incretin hormones. On the one hand, they provide a stimulating effect on the work of the pancreas, and on the other hand, they block the production of glucagon, which is an insulin antagonist. But the distinguishing feature of the drug is the fact that it only works when there is an increasing volume of sugar in the blood. The main representatives are Januvia, Galvus, Ongliza and other names. With such means, the chance of developing hypoglycemia does not increase. There is no weight gain with them. At the same time, these drugs can be combined with other medicines for diabetes, such as metmorphine.
Mimetics, GLP-1 analogues
The main representatives of this series are Victoza, Byeta. In fact, this type of drug works similarly to gliptins. These funds are injected subcutaneously. They allow you to gradually reduce the patient’s weight, do not provoke an increase in the likelihood of hypoglycemia. This group of drugs is often prescribed for elderly patients with diabetes and severe obesity, if the patient is able to give himself injections. These drugs are most often the line that separates the patient from insulin therapy.
Alpha glucosidase inhibitor
The most popular representative is Acarbose. Medicines of this series are aimed at blocking the processes of absorption and absorption of glucose in the bloodstream. That is, the effect is initially on the mechanism of processing substances in the intestine. Given the characteristics of drugs of this type, they often give side effects from the gastrointestinal tract. Therefore, the use of this drug is often difficult for older people.
Many diabetes medications have side effects that subside over time (in about a few weeks). But some of them can lead to weight gain, fluid retention, osteoporosis and accelerated progression of heart failure.
Difficulties of treatment
“Adult” diabetes is difficult to treat for a variety of reasons. In older people, as a rule, there is a whole bunch of comorbidities that interfere with the effect of the necessary drugs on the course of the disease. Elderly people are not always easy to learn, sometimes it is difficult to convince them of the need for treatment, they are inclined to switch to folk remedies for combating the disease, which may not always have the desired effect. Many older people have anorexia, which is accompanied by a natural decrease in muscle mass, as well as depression, which does not contribute to the successful absorption of medications. For diabetics with senile dementia or Alzheimer’s disease, the care and concern of relatives or specially hired people is very important. They must strictly monitor the dose of hypoglycemic drugs, as well as the indispensable consumption of food within 30 minutes after taking them.
Individual approach and attention to each patient
In any case, the treatment is strictly individual. Each person comes to the end of his life with his personal baggage, in which there is a whole heap of different parameters and conditions that characterize his physical and mental health. Diabetes itself often leads to complications. All this aggravates and limits the possibilities for healing. In addition to the severity of the diabetes itself, the doctor should consider the following when prescribing a treatment regimen:
- The patient’s age;
- The state of the cardiovascular system;
- The likelihood and tendency to develop a state of hypoglycemia;
- The mental and mental state of the patient and the ability to follow the doctor’s prescriptions;
- Possible risk of developing diabetic complications.
The blood sugar level of mature diabetics should be lowered evenly and smoothly, avoiding sudden surges and changes. Strive for the maximum permissible level of glucose concentration no more than 7-8 mmol / l.
With a diabetic diagnosis, it is good to keep a condition diary, in which it is necessary to record the measurement results of the following parameters:
- Blood glucose levels;
- Indicators of “bad” (low-density) cholesterol in the blood;
- Triglyceride levels;
- Blood pressure indicators.
Sugar measurements are taken during the following periods:
- With insulin therapy and the use of hypoglycemic drugs – before meals and a few hours after it;
- When the patient feels hunger;
- If necessary (in case of danger of hypoglycemia) – at night.
The diary should also contain other information that relates to:
- Time of reception and description of the food consumed;
- Doses of injected insulin or taken antihyperglycemic drugs;
- Stress arising spontaneously or constantly present;
- The presence and description of concomitant diseases.
Keeping a diary greatly facilitates the doctor’s task of prescribing or adjusting the existing treatment, since it clearly reflects the course and dynamics of the disease. The diabetic himself can also analyze the influence of many factors on his condition on the basis of the records made and, if possible, react situationally.
The diet of an elderly diabetic. Basic tasks and rules
The diet of a person with type 2 diabetes is designed to compensate for his condition and, therefore, should solve the following tasks:
- Ensure a constant low blood glucose level;
- Promote weight loss (if any) while providing sufficient energy for the patient’s ability to move;
- Contain a sufficient amount of proteins, as well as vitamins and minerals;
- Ensure the normal functioning of the digestive tract;
- Include a sufficient amount of fluid, the maximum allowed for the current condition of the patient’s heart and kidneys.
The basic rules of the diet for an elderly diabetic are as follows:
- Eat fractionally, in small portions;
- Divide the entire daily rate into 5 receptions in the following proportions: 25% – breakfast and dinner, 30% – lunch, 10% – afternoon tea, at night – 10% (a glass of kefir or unsweetened yogurt);
- Cook or bake dishes, stew – rarely, fry – absolutely impossible;
- The starting point for compiling the menu is the number of bread units and the glycemic index of products;
- Warm drinks, not cold ones (for better absorption);
- 600 g of vegetables daily;
- Bread – only black;
- Curd – required;
- Mustard – exclude;
- Greens, garlic and horseradish – you can;
- Cholesterol-rich foods – exclude;
- Alcohol, as well as fatty, spicy, smoked and salty – exclude;
- The daily calorie content is calculated for a specific person, taking into account his age and weight.
As it became clear from the above, therapy in the elderly requires particularly pedantic selectivity. Moreover, exercise therapy and diet therapy are the most important parts of such treatment. But at the same time, one cannot neglect the drug effect. The doctor will help you choose a specific range of drugs based on the patient’s condition. Thanks to this, it will be possible to maintain health at the highest possible level.