Diabetes Mellitus

DIABETES AND SENIORS

Written by StopDiabetes

How does a person’s response to diabetes change as he or she ages?

As people with diabetes age, their bodies change along with their response to diabetes. For example, sometimes the method of monitoring blood glucose levels or administering insulin must change as a person gets older, especially if he or she is having difficulty with cognitive function. For some older people, aging with diabetes may mean a new routine, such as changing from using a syringe for insulin injections to an insulin pen. Or it can mean a major lifestyle change, such as engaging in more physical activity to keep blood glucose levels under control.

Why is it often difficult to determine how aging affects a person with diabetes?

There is one major reason why researchers and health care professionals find it difficult to determine how aging affects a person with diabetes: We don’t have enough data (such as a good cross-section of older people who have had the disease for very long) to understand what happens. It is true that insulin has been available for less than a century. But, as of this writing, few elderly people have been on insulin long enough for scientists to collect long-term data of how older people live with diabetes. There is a positive aspect even though there is less data about aging and diabetes. Managing diabetes has changed since the mid-twentieth century, with more technology and medications to treat diabetes no matter at what stage of life—and there is also a better understanding of the disease.

Do menopausal women have more type 1 or type 2 diabetes?

In general, most statistics show that most menopausal women who develop diabetes have type 2. This is because many menopausal women tend to gain weight after their childbearing years. The more a woman weighs, the more risk for developing type 2 diabetes, especially if it runs in her family.

How is menopause connected to diabetes in women?

If a woman is menopausal, she faces challenges even if she does not have diabetes, and if she does, bodily changes complicate the illness, especially its management. Bodily changes occur because two major hormones—estrogen and progesterone—are not stable. (In fact, a higher level of estrogen usually improves insulin sensitivity, while higher levels of progesterone cause resistance.) According to the Mayo Clinic, the following lists several possible effects on a woman’s body that can increase the risk of diabetes (for those who do not have the disease or are prediabetic) or exacerbate the problems associated with a menopausal woman who has diabetes:

Gaining weight—If a menopausal woman gains weight during the transition and after menopause, she may also cause an increase in blood glucose levels. This could increase the need for insulin or oral diabetes medications.

Blood glucose level changes—The two major female hormones, estrogen and progesterone, both affect how a woman’s cells respond to the natural insulin in her body. After menopause, the levels of these hormones change and thus can cause fluctuations in the woman’s blood glucose levels. This may also cause changes in how her body responds to glucose and insulin, which in turn can lead to a higher risk of dia betes and its complications.

Infections of the urinary and reproductive tracts—Because of the fluctuations in blood glucose levels after menopause—especially the high glucose levels—a woman can more easily develop urinary and vaginal infections. In fact, the drop in estrogen levels in a menopausal woman allows bacteria and yeast to thrive in the urinary tract and vagina, increasing the risk of infections.

Sleep problems—Many women experience trouble sleeping after menopause, most often because of hot flashes and night sweats. Because of the lack of sleep, along with the stresses associated with having hot flashes and night sweats, many women with diabetes find it more difficult to manage their blood glucose levels. Even women who do not have diabetes can be affected by lack of sleep, as the stress causes blood glucose levels to rise.

Is there an osteoporosis–menopause connection in women?

Yes, there is often thought to be a connection between osteoporosis (see sidebar) and menopause in women. In particular, after a woman reaches menopause, and if she has a more sedentary lifestyle, she is at increased risk for osteoporosis. There is also an increased risk of the disease if the woman is thin or has a small frame, if she has a family history of the disease, or if she takes certain medications or has certain illnesses that leach or stop the absorption of calcium in the body. In women after menopause, osteoporosis is called primary type 1 or post-menopausal osteoporosis; after age 75, it is often called primary type 2 or senile osteoporosis.

Can type 1 and/or type 2 diabetes affect a menopausal woman’s bone density?

Yes, there seems to be a connection between menopause in a woman with type 1 diabetes and lower bone density, but no one is sure why. Some researchers believe that it may be because insulin, which is deficient in women with type 1 diabetes, may help promote bone growth and strength. Others believe cytokines (substances produced in many cells of the body’s immune system that have an effect on other cells) may play a role not only in the development of type 1 diabetes but also in osteoporosis.

What is osteoporosis?

Osteoporosis (from the Greek, meaning “porous bones”) is a disease in which a person’s bone-mineral density decreases because of the lack of certain elements in the body, including calcium and vitamin D. This causes the bone to break down and increases the risk of fractures and breaks, usually in older adults (female and male) and especially in post-menopausal women. (For more on osteoporosis and diabetes, see the chapter “How Diabetes Affects Bones, Joints, Muscles, Teeth, and Skin,” and for more about vitamins and minerals, see the chapter “Diabetes and Nutrition.”)

There is one additional statistic that researchers are examining: Although women with type 1 diabetes are at a higher risk overall for osteoporosis, the risk seems to be even more pronounced for overweight women with type 2 diabetes. It is thought that increased body weight can reduce the risk of osteoporosis, but it also increases the risk of type 2 diabetes. But studies have shown that although bone density increased in women with type 2 diabetes, fractures also increased.

Some suggest that people with type 1 diabetes also experience more fractures—and that these may be due to an increased number of falls because of poor vision and nerve damage caused by the disease. Others suggest that diabetes may damage bone structure and quality, causing a decrease in bone density.

How many Americans over age 60 are thought to have insulin resistance?

It is estimated that 40 percent of Americans over age 60 have some insulin resistance. This means that the cells in the body become less sensitive to the hormone and need larger amounts of insulin to metabolize certain compounds in the body, such as proteins, fats, and carbohydrates. And it is not only people with diabetes who are affected by insulin resistance. It also can affect those who suffer from obesity and hypertension and those with impaired glucose tolerance. (For more about insulin resistance, see the chapters “Introduction to Diabetes” and “Prediabetes and Type 2 Diabetes.”)

Can older people’s sense of taste and smell affect their eating habits—and their diabetes?

Yes, older people (with or without diabetes) do not have as keen a sense of smell or taste as when they were young—and these factors may affect their eating habits. In general, it is thought that a person’s sense of smell peaks between ages 30 and 60. After 60, a person’s ability to smell and taste declines. With further aging, especially over age 80, people lose even more of their sense of smell and their ability to discriminate between smells (medically called olfactory impairment). Research has shown that more than 75 percent of people over 80 have some decline in smell.

Overall, the reason for a decline usually has to do with the normal aging process, drug use (possibly including some medications associated with diabetes), infections (especially upper respiratory), changes in the mouth (such as dentures or tooth loss), and even the reduction of saliva. Thus, because smell and taste are so intertwined with a person’s perception of foods and eating habits, a large proportion of elderly people who lose their smell don’t eat well and become nutrient deficient, and for older people with diabetes, this can be a problem, as it may cause them to eat poorly, which can affect their ability to control blood glucose levels. (For more about diabetes, smell, and taste, see the chapter “Diabetes and Inside the Human Body.”)

What are some other eating challenges that can affect an older person with diabetes?

Seniors with diabetes face many challenges, especially taking in enough nutrients to stay healthy. This can be for a multitude of reasons, including a loss of appetite (from medications or illness), problems with chewing and swallowing (difficulty with dentures or lack of teeth), and a need to reduce the intake of fats and sugars that are associated with certain chronic conditions (sugars and fats provide energy but also add weight that can lead to other diseases). All these conditions can (and often do) create problems with an older person’s blood glucose levels.

Is there a connection between complications from diabetes and dementia?

Although more studies need to be conducted, according to research published in 2015 in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism, people who have diabetes and experience high rates of complications are more likely to develop dementia as they age than people who have fewer diabetic complications. In particular, the researchers noted that when blood glucose levels remain high because of uncontrolled diabetes, complications such as blindness, kidney failure, and decreased blood flow in the extremities can occur. These complications, in turn, seem to be connected with the development of dementia as the person ages. (For more about dementia—including Alzheimer’s disease—see the chapter “How Diabetes Affects the Nervous System.”)

What are peripheral neuropathy and orthostatic hypertension, often complications of diabetes and aging?

Peripheral neuropathy is nerve damage affecting the long nerves that run from the spine to the arms, legs, and hands. Orthostatic hypertension is a form of autonomic (occurs unconsciously) neuropathy that affects a person’s balance. Both are often complications of type 1 and type 2 diabetes and the aging process. (For more about peripheral and autonomic neuropathies, see the chapter “How Diabetes Affects the Nervous System.”)

One possible complication of diabetes is peripheral neuropathy, which affects the nerves leading to extremities such as the feet, but it can also affect hands, arms, legs, facial muscles, and internal organs.

One possible complication of diabetes is peripheral neuropathy, which affects the nerves leading to extremities such as the feet, but it can also affect hands, arms, legs, facial muscles, and internal organs.

Who are some famous historical figures who have had diabetes?

Many historical figures have had diabetes—some with complications that greatly affected their lives and even their decisions over time. The following are only a few examples:

  • American Thomas Edison (1847–1931), inventor and businessman, managed to produce a prolific amount of patents while suffering from diabetes (this was before insulin was introduced)—including the phonograph, motion-picture camera, and the long-lasting, practical lightbulb.
  • George R. Minot (1885–1950) received the Nobel Prize (with two others) for studies in anemia. He was also diagnosed with diabetes in 1921 and was one of the first patients to be treated with the “new drug” insulin by Banning and Best (see above for more information). He had developed complications from diabetes by 1940, had a serious stroke in 1947, and died in 1950.

Who are some famous politicians who have had or have diabetes?

Many well-known politicians have had or have diabetes. The following lists only a few of those people:

  • American politician Fiorello LaGuardia (1882–1947), the former (and 99th) New York City mayor and namesake of LaGuardia Airport in New York, was a diabetic.
  • Mikhail Gorbachev (1931–) was the general secretary of the Soviet Union from 1985– 1991 and a Nobel Peace Prize winner (1990). He was also instrumental, along with U.S. President Ronald Reagan in ending the Cold War between the United States and the Soviet Union. In 2014 he was diagnosed with “an acute form” of diabetes.
  • Yuri Andropov (1914–1984) was the general secretary of the Communist Party of the Soviet Union from November 1982 until his death 15 months later. Toward the end of his life, he had several health problems, including hypertension and diabetes, which were connected to chronic kidney deficiency. He eventually died from toxicity in his blood (mainly due to renal failure he had experienced the year before).

Who is Theresa May?

In 2016, after the United Kingdom voted to leave the European Union and Prime Minister David Cameron resigned, Theresa May, 59 at that time, became Britain’s 76th prime minister. She is also thought to be one of the first major world leaders with type 1 diabetes. May was diagnosed with diabetes later in life, seeking medical attention in 2012 for sudden weight loss, fatigue, and thirst. At first, she was misdiagnosed with type 2 diabetes, but then she was surprised to learn she had actually developed type 1. (Like many people, she assumed that at her age, she would not get the disease, but it can develop at any age; for more about adults and type 1 diabetes, see the chapter “Type 1 Diabetes.”) Since that time, she has been open about her diabetes, indicating that she has been able to effectively manage her condition and her responsibilities as prime minister. According to several reports, she does admit that she has to be a little more careful about what she eats and has to take injections, but that situation, she has said, is something that millions of people have. In fact, many people who have type 1 (and type 2) diabetes look to May as an example of what can be accomplished as long as they manage their diabetes sensibly.

 

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