Doctors face more challenges when treating Type 1 Diabetes on elderly than in younger people. For example, it is more difficult to make sure they use a correct dose of insulin, have them do enough exercise and keep them on a proper diet.
Insulin is still the standard medication for an elderly with Type 1 Diabetes, although it is not always possible to control their blood glucose properly. Doctors can’t try to achieve seven percent or less of hemoglobin A1c, as at this stage of life, it can lead to a significantly reduced quality of life and repeated episodes of hypoglycemia. It is important to decide whether you should choose a basic or intensive treatment.
• Basic treatment: You are required to avoid excessive thirst and urination, which allow you to feel rested and get better sleep quality. When you undergo this treatment, the goal is to keep your blood glucose level under 200mg/dl. In most cases, it can be achieved by taking one shot of insulin glargine before breakfast and moderate doses of rapid-acting insulin before lunch and dinner. Other patients may get a more simple treatment regimen, a mixture of intermediate- and short-acting insulin, taken twice each day. It is advisable to use insulin pens to ensure easier administration. Elderly people with other significant medical conditions, who are not expected to have long life expectancy, may receive basic treatment simply to reduce discomfort.
• Intensive treatment: The goal is to lower your hemoglobin A1c, until it reaches seven percent or lower, which is necessary to avoid microvascular complications. The treatment is performed on elderly with Type 1 Diabetes, with relatively better health and has longer life expectancy. Microvascular complication can cause nerve, kidney and eye diseases if not treated immediately. In this type of treatment, an insulin pump may be necessary to help you remember the amount of insulin you should take.
During both treatments, elderly should test blood glucose level each day as researches show that patients who perform daily test can control their blood glucose level better. Additionally, every three months, your doctor should test for your hemoglobin A1c level. Other important tests are blood fats (annually), blood pressure and weight (every visit) and microalbumin (annually).
Because elderly tend to have higher insulin resistance, some doctors may prescribe metformin, which can lower the glucose release from the liver. The common dose is 500 to 1000 mg pills taken three times daily after each meal. It is inadvisable to use insulin sensitizer from the thiazoledinedione class, such as pioglitazone and rosiglitazone, which can make your body more sensitive to insulin. They may cause some side effects such as osteoporosis, anemia and excessive weight gain. The rosiglitazone in particular is proven to increase the risk of early heart attack. When visiting a doctor, it is recommended to bring all your medications to help the doctor to decide whether you should continue the medication regime.
Despite the fact that more and more elderly people have both Type 1 and Type 2 diabetes, there are only a few researches conducted to target the nutritional needs for diabetics at this age group, typical recommendations are based on studies for younger patients. But it is commonly known that elderly may get malnutrition easily, due to eating wrong foods and get improper amounts of calories. Retired elderly may have more financial constraints, which force them to seek a balance between medications, foods and pleasures (like movie or travel). Because the problem is related to economic and social issues, it could be harder to fix.
These are some nutritional recommendation for elderly people with Type 1 Diabetes:
• Take a mineral tablet and vitamin supplement each day to ensure an adequate daily intake of essential nutrients.
• Carbohydrate should make up 45 percent of your daily calories intake. This recommendation is based on blood glucose level in diabetic patients.
• Protein should make up 20 percent of your daily calories intake. It is an optimum balance, as too little protein can cause the loss of muscle mass and too much protein can damage your kidneys.
• Get about 25 grams of fiber each day.
• Avoid low sugar diet as it won’t control your glucose level. The lack of taste may cause the loss appetite and insufficient nutrition intake.
• Ensure an acceptable dental health to avoid infections (which are likely to happen on diabetics) and make eating easier.
Many elderly people with Type I Diabetes complain that they can’t exercise because they:
• Have joint problems
• Have chest pain
• Have no time
• Can’t enjoy it
• Can’t catch their breath
The lack of exercise on elderly is another reason why exercise is a habit that should be established on the youngest age possible.
An elderly with Type 1 Diabetes should walk about 30 minutes each day whenever possible. People with balance problems can use stationary cycle or exercise indoor to lower the risks of accidents, while those with joints problem, should use elliptical trainer to avoid trauma to joints while achieving good workouts. Additionally, light weight lifting should complement aerobics because it is very beneficial to elderly with Type 1 Diabetes. It allows them to increase their stamina, improve their balance and regain strength in their muscle.
Those just starting to exercise have some risks:
• Hemorrhage of the eye vitreous
• Possible heart attack
• Retinal detachment
• Joint and soft tissue injury
• High blood glucose after an intense exercise
• High protein level in the urine
People above 50 should undergo thorough cardiology and eye exams before starting vigorous exercise sessions.