Diabetes in older people--a disease you can manage. (Common Health Concerns: Learn more about the medical concerns you might have.

Diabetes is a serious disease. It happens when your blood levels of glucose, a form of sugar, are too high. Diabetes can lead to dangerous health problems. The good news is that high glucose levels can be managed to help control the disease and prevent or delay future problems.

What is Diabetes?

Our bodies change the foods we eat into glucose. Glucose travels through the bloodstream to "fuel" or feed our cells. Insulin is a hormone that helps our bodies use glucose for energy. People with diabetes either do not make insulin, do not use insulin properly, or both. This means they have too much glucose (sugar) in their blood. As a result, they often feel tired, hungry, or thirsty; they may lose weight, urinate often, or have trouble with their eyes. In time, the high levels of this form of sugar in the blood (glucose) can hurt their eyes, kidneys, and nerves. It can also cause heart disease, strokes, and even the need to remove all or part of a limb (amputation).

Diabetes tends to run in families, but other factors add to the risk of getting diabetes. For example, being overweight and underactive can sometimes trigger diabetes in people who are at risk. There is a lot of research underway looking at what causes diabetes and how best to manage it.

But there is a lot we do know. For example, we know that careful control of blood glucose, blood pressure, and cholesterol can help prevent or delay diabetes and its complications.

Types of Diabetes

There are two types of diabetes. In one kind, people must take insulin every day. This is called type 1 diabetes, formerly known as juvenile-onset diabetes. Type I diabetes is often first seen in children, teenagers, or adults under age 30.

The second kind of diabetes happens when the body produces insulin but doesn't use it in the right way. This is called type 2 diabetes, formerly called adult-onset diabetes. It is most common in people over age 40. Type 2 diabetes is linked to obesity, lack of activity, family history of diabetes, and family background. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at very high risk for type 2 diabetes.

There is also a condition called prediabetes in which blood glucose (a form of sugar) levels are higher than normal but not high enough to be called diabetes. This condition raises the risk of type 2 diabetes, heart disease, and stroke. People with pre-diabetes can delay or prevent type 2 diabetes by losing weight and being more active.

Related Health Concerns

Blood glucose levels that are either very high or very low can lead to serious medical problems, even emergencies. In addition to the health problems noted above, people with diabetes could go into a coma (become unconscious) if their blood glucose levels get very high. Low blood glucose (called hypoglycemia) can also cause problems if it's untreated. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrates such as bread, fruit, potatoes, or milk. But, left untreated, hypoglycemia can lead to loss of consciousness. Although hypoglycemia can happen suddenly, it can usually be treated quickly, bringing your blood glucose level back to normal.

Researchers recently have found that people with diabetes also have an increased risk for Alzheimer's disease. Studies are underway to understand this connection and to see whether strict control of glucose can delay or prevent this problem.

Symptoms

Often, people with type 2 diabetes have few or no symptoms. Many people with type 2 diabetes don't even know they have it. For some people, feeling rundown is their only symptom. Other people may feel thirsty, urinate often, lose weight, have blurred vision, get skin infections, or heal slowly from cuts and bruises. It is very important to tell the doctor right away about any of these problems.

Tests

Medical tests will show if diabetes is causing your problems. A doctor can diagnose diabetes by reviewing your symptoms and checking your blood glucose levels. One test (fasting plasma glucose test) measures your blood glucose level after eating or drinking nothing (fasting) for at least eight hours, usually overnight. In another test, called the oral glucose tolerance test, your blood glucose is checked and then you drink a sugary beverage. Your blood glucose (sugar) levels are then checked I hour, 2 hours, and 3 hours later. Diagnosis is confirmed after a repeat test on a different day.

Research shows that some increase in blood glucose levels often comes with age. This may be caused by weight gain, especially when fat builds up around the waist. Managing Diabetes

There are things you can do to take control of your diabetes.

* Meal planning and eating correctly are key to managing blood glucose, blood pressure, and cholesterol levels. To plan meals and eat right, you need to understand how different foods affect your glucose levels. A good meal plan will take into account your food likes and dislikes, goals for weight control, and daily physical activity. Health care professionals can work with you to create a personalized meal plan.

* Physical activity is very important in dealing with diabetes. Taking part in a regular fitness program can improve blood glucose levels in older people with diabetes. A health care professional can help plan a physical activity program just right for you.

* Medications are also central to controlling diabetes for many people. Doctors may prescribe oral medicines (those taken by mouth), insulin, or a combination of both as needed. People with type 2 diabetes may not need to take diabetes medications if they can reach glucose, blood pressure, and cholesterol goals through meal planning, eating the right foods, and physical activity.

* Keeping track of how well your diabetes care plan is working is important. Check blood glucose levels and monitor your blood pressure and cholesterol levels.

What Else Can You Do?

Eye Exams. People with diabetes should have an eye exam every year. Finding and treating eye problems early can help prevent more serious conditions later on.

Kidney Check. A yearly urine test for a protein called albumin will show whether your kidneys are affected by diabetes.

Foot Care. Diabetes can reduce blood supply to arms and legs and cause numbness in the feet. People with diabetes should check their feet every day and watch for any redness or patches of heat. Sores, blisters, breaks in the skin, infections, or build-up of calluses should be checked right away by a doctor specializing in foot care (podiatrist) or a family doctor.

Skin Care. People with diabetes can protect their skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises to prevent infections and other problems.

Care of Teeth and Gums.

Working closely with a dentist is very important. Teeth and gums need special attention to avoid serious infections.

Flu Shots and Pneumonia Vaccine. Getting a yearly flu shot and a pneumonia vaccine at least once will help keep people with diabetes healthy. If five years or more have passed since your pneumonia shot, ask your doctor if you should be revaccinated.

People with diabetes who are on Medicare now receive coverage for supplies such as glucose monitors, test strips, and lancets. For more information about what is covered, call 800-MEDICARE (800-633-4227).

For More Information The following organizations offer a wealth of information, as well as free or low-cost resources for people with diabetes, health care professionals, and the general public:

National Diabetes Education Program One Diabetes Way

Bethesda, MD 20814-9692

800-438-5383 (toll-free)

www.ndep.nih.gov

American Diabetes Association 

1701 North Beauregard Street

Alexandria, VA 22311

800-342-2383 (toll-free)

www.diabetes.org

National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Information Clearinghouse One Information Way

Bethesda, MD 20892-3560

800-860-8747 (toll-free)

301-654-4415

www.diabetes.niddk.nih.gov

For more information about health and aging, contact:

National Institute on Aging Information Center P.O. Box 8057 Gaithersburg, MD 20898-8057 800-222-2225 (toll-free) 800-222-4225 (TTY/toll-free)

* To order publications (in English or Spanish) online, visit www.niopublications.org.

* The National Institute on Aging website is www.nin.nih.gov.

* Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This simple-to-use website features popular health topics for older adults. It has large type and a "talking" function that reads the text out loud.

July 2004