Mr. Zhang is 65 years old this year. He has always been tough, but one day he felt dizzy after eating. After going to the hospital for examination, I realized that my blood sugar was too high after meals and I had diabetes. The doctor explained to Mr. Zhang: This is caused by the decline of pancreatic function with age. As long as it is properly controlled, there is still a chance to keep blood sugar stable.

Mr. Zhang is a little puzzled, doesn’t it mean that high blood sugar in the elderly is no problem? Many people do not recommend that the elderly take hypoglycemic drugs, so how to manage diabetes in the elderly? What issues need to be paid attention to, and what are the control objectives? Today, I will take you to know about diabetes in the elderly and the five control goals that you need to know!

Why do you have diabetes? Causes of diabetes in old age

Decreased number and function of pancreatic beta cells

In general, pancreatic beta cells secrete insulin, which stabilizes the performance of blood sugar. However, with age, the number of pancreatic beta cells will gradually decrease, gradually causing blood sugar imbalance. The most common initial symptoms are postprandial hyperglycemia rather than abnormal fasting blood glucose.

High blood sugar after meals is also known as glucose intolerance. Refers to the oral glucose tolerance test, but the blood sugar after two hours is 7.8-11.1mmol/L, and the normal value should be less than 7.8mmol/L.

Insulin resistance

Because of a slower metabolism, older adults who do not exercise regularly are at risk of gaining belly fat, losing muscle mass, and gaining weight. Combined with the effects of aging of the body, such as decreased hormone production, oxidative stress, and chronic inflammation, it increases insulin resistance and increases the risk of diabetes.

chronic inflammation

Studies have found that the elderly have more substances that cause inflammation, which will increase the body’s inflammatory stimuli, such as skin inflammation, arthritis, soreness, fatigue, etc., and also increase the risk of insulin resistance and diabetes.

Diagnosis of diabetes in the elderly

Diabetes in the elderly is diagnosed in the same way as general diabetes. As long as two of the following points are met, or repeated tests of the same item meet the diagnostic criteria, diabetes will be diagnosed:

Fasting blood sugar≥7mmol/L

Oral glucose tolerance test, blood glucose ≥11.1mmol/L after two hours

There are three more symptoms and one less symptoms, and the random blood sugar is ≥11.1mmol/L

There are also medical institutions that will consider the glycated hemoglobin standard, mainly if the glycated hemoglobin ≥ 6.5, it can also be determined.

There are many elderly diabetic patients with normal fasting blood glucose in the initial stage, but in fact the oral glucose tolerance test is greater than 11.1mmol/L. Therefore, it is recommended that people aged 40-64 should be tested every 3 years; and the elderly over 65 should also be tested every year, and pay more attention to their physical conditions, so as not to miss the golden opportunity for treatment!

4 characteristics of diabetes in the elderly

As the age increases, the body’s function will gradually decline, so elderly diabetic patients are prone to other elderly symptoms or diseases, making the overall blood sugar control more difficult:

Higher risk of hypoglycemia

Because the autonomic nervous system’s responsive function is more degraded, it is less sensitive to symptoms of hypoglycemia. When hypoglycemia is detected, there is often already severe cognitive impairment. After getting older, malnutrition and irregular eating may also be caused by poor teeth or appetite; even due to organ degeneration, liver and kidney functions may decline, affecting the metabolism, storage, and use of various drugs, etc., which will increase hypoglycemia. risks of.

have multiple chronic diseases

Studies have shown that 60% of elderly diabetic patients suffer from more than one complication at the same time, such as cardiovascular disease (high blood pressure, heart failure, stroke), cancer, arthritis, sarcopenia, dysuria, obesity, etc. These can make blood sugar control more difficult.

Concomitant geriatric syndrome

Geriatric syndrome refers to the phenomenon of physical and cognitive dysfunction, depression, easy falls, urinary incontinence, insomnia, frailty, and malnutrition when people are old. Diabetes itself is a high-risk group of depression and malnutrition, and long-term hypoglycemia will also increase the incidence of Alzheimer’s disease. Therefore, elderly diabetic patients are likely to be accompanied by these problems at the same time.

May have sarcopenia

Muscle mass will gradually lose with age. It starts around the age of 60, and the annual loss rate is 3%. Therefore, if you don’t have the habit of exercising and you don’t have enough protein and calories in your diet, you can easily gain muscle mass. sarcopenia. Once the body loses muscle, it affects the muscle’s ability to store and use glucose, making blood sugar management more difficult.

4 major control goals for elderly diabetes, multi-faceted stability can protect health

In view of the above four major characteristics, it is not difficult to find that when taking care of elderly diabetic patients, in addition to managing blood sugar, it is also necessary to regularly follow up and check, go to the hospital or related medical institutions to conduct a complete medical evaluation of the elderly, and take comprehensive care. Work. And setting management goals is also very important. Here are some of the more common goal plans for everyone:

1. Blood sugar and blood pressure target: make individual settings according to the situation

According to a study, there is a U-shaped relationship between glycosylated hemoglobin and mortality in elderly diabetic patients. Simply put, the glycated hemoglobin should not be too low or too high, just keep it at 7.5. It is safer to set individualized goals for older people with diabetes based on factors such as current physical condition, cognitive function, number of complications and comorbidities, and risk of hypoglycemia!

If it is an elderly person without disease, fasting blood sugar is 5-7.2mmol/L, postprandial blood sugar is 5-8.3mmol/L, glycosylated hemoglobin is less than 7.5, and blood pressure is less than 140/90mmHg;

If it is an elderly person with fewer complications, fasting blood sugar is 5-8.3 mmol/L, postprandial blood sugar is 5.6-10 mmol/L, glycosylated hemoglobin is less than 8, and blood pressure is less than ¹⁴⁰⁄₉₀ mmHg. Blood pressure control should be more strict in patients with kidney disease. Some;

If it is an elderly person with more complications, the fasting blood glucose is 5.6-10 mmol/L, the postprandial blood glucose is 6.1-11.1 mmol/L, the glycosylated hemoglobin is less than 8.5, and the blood pressure is less than ¹⁵⁰⁄₉₀ mmHg;

2. Blood lipid target: appropriate control to reduce the risk of cardiovascular disease

Because blood lipids are closely related to the occurrence of cardiovascular diseases, it is also very important to do a good job in blood lipid management and control. Low-density cholesterol (LDL) is recommended to be less than 2.59mmol/L; for patients with existing cardiovascular disease, it is recommended to be less than 1.8mmol/L. If you still can’t reach the standard, you can combine drug treatment under the doctor’s instruction to reduce the risk of cardiovascular disease.

3. Sports goals: arrange sports according to physical conditions

Elderly diabetic patients also need to exercise 150 minutes per week, but remember to arrange exercise programs according to their current physical condition and whether there are other complications:

When doing aerobic exercise, it is necessary to start with a light form without additional stress, such as indoor cycling, walking, etc. After allowing the body to adjust, gradually increase the intensity of the exercise to avoid excessive exercise, resulting in hypoglycemia or exercise harm.

When doing strength training, you can do it every 2-3 days with 8-12 repetitions per set, which will help increase muscle mass and muscular endurance. If you are worried that you will lose your weight and fall when you hold the equipment, you can also sit on a chair and perform simple exercises. For example: hold the barbell in one hand and lift it up slowly and back and forth; or straighten your back, raise your right thigh, then straighten your calf forward, and then lower it back down.

4. Nutritional goals: balanced intake of nutrients to reduce the risk of disease

Decreased gastrointestinal absorption, bad teeth, difficulty swallowing, poor appetite and other problems often make the elderly suffer from insufficient calorie intake and uneven nutrition. It is recommended to do a nutritional and dietary evaluation every year, and a dietitian will give the most suitable dietary advice to reduce the risk of hypoglycemia and sarcopenia.

Elderly diabetic patients who already have sarcopenia should eat 3-4 servings of protein at each meal, such as milk, tofu, soy milk, fish, eggs, chicken, pork and beef, in addition to adequate calorie intake. Great protein choice! According to the nutrition survey, the elderly over 70 years old generally have insufficient vitamin D intake. This is not only prone to bone pain and muscle weakness, but also increases the risk of osteoporosis. In addition to eating a balanced diet, you can also walk outdoors and sunbathe for 10 minutes every day to help absorb vitamin D and increase your mood.

Although the years are not forgiving, as long as you develop good living habits and pay attention to your physical condition from now on, you can still reduce the risk of diseases and prevent the appearance of other geriatric syndromes. Take care of your own health, the life of the elderly can be colorful!