Diabetes

DiabetesDiabetes among the Elderly

The age factor is very crucial in medicine. The metabolism and physical conditions change with advanced age. The elderly need special attention, especially when there are further critical conditions diagnosed, such as diabetes.

What happens when people get older?

In young adults, the percentage of muscles in the body mass is in general much higher than the percentage of fat. When people grow older, this ratio tends to reverse; the mass portion of fat becomes more than of muscle. The more body fat a person has, the higher the resistance to insulin will become. This insulin resistance causes the body to absorb less sugar from the blood, resulting in a raised sugar content in the blood and the body does not get enough energy. So, as a natural consequence of the advanced age, approximately 10% of elderly people will have glucose (sugar) metabolism problems.

Additional considerations for treating elderly diabetic patients

When treating an elderly diabetic, doctors need to also consider the function of the organs. Even without a disabilitating disease such as diabetes, the organs’ functions decrease with age. When added complexity occurs with diabetes, the functions can decrease significantly.

One of the most common complications with elderly diabetic patients is hypoglycemia, a condition where the blood sugar is below normal, causing the body to not receive enough energy. When the blood sugar level is very low, some body cells can even die. Most importantly, the brain cells are the most sensitive to this hypoglycemia condition. So it reduces the function of the brain and even may cause death.

With a higher insulin resistance and a decreased function of the pancreas, the organ which produces insulin, an elderly diabetic patient needs a higher dose of medicine to reach the required insulin level needed by the body and needs to control the blood sugar. Also with age, the kidney function decreases. The kidney is important to eliminate metabolites (residuals) of chemicals, including drugs. If the metabolites are on a higher level than normal, this may cause serious effects, for example it may contribute to lower the blood sugar level further, as it frequently occurs in diabetic medicine. So with a higher dose of medicine and less elimination by the kidney, hypoglycemia is much more likely to occur.

Another mechanism to result in hypoglycemia is the reduced sensitivity of body responses with the elderly. In a healthy young person, once there is a hypoglycemia condition the body will try to regulate this condition early and try to increase the blood sugar level before permanent damage occurs. With elderly people this mechanism will not work as effectively any more. The body’s response will be too late when the blood sugar level becomes very low, which might already cause damage to the cells.

What is the most suitable therapy of diabetes?

 

The first and most important is lifestyle modification. All diabetics need to modify their diet and their level of physical activity. If the blood sugar level is still not under control they will need medication. There are many diabetes medicines in the market. The choice of which medicine is to be used depends on many factors, e.g. the individual’s kidney function, patient compliance, and potential side effects.

Insulin Therapy – a brief analysis

Advantages:

  • Natural treatment for diabetic patients.
  • No side effects.
  • Easy to adjust the dosage.

 

Disadvantages:

  • Patients are reluctant to start the ‘injection’ treatment,
  • Weight gain,
  • Patients fear hypoglycemia, although, with good monitoring and proven from studies, insulin therapy does not have a higher hypoglycemia incidence.

 

Previously, insulin injection seemed to be the last resort for diabetics, in the case that no oral medication was succeeding in regulating the blood sugar level. This understanding has changed. Insulin is now the “ideal” diabetes medicine, even for early cases.

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BIMC Hospital Nusa Dua
The first hospital in Indonesia with accreditation from Australian Council on Healthcare Standard International  (ACHSI)

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