6 Challenges of Aging With Diabetes
How to overcome your body’s natural changes
About one in four Americans over the age of 60 have diabetes. Managing the disease can become more difficult as people enter their 60s, 70s, and 80s. Here's what experts have to say about the challenges of aging and what you can do to overcome them:
Two of the most important things aging people can do is admit that they need help and ask for it, says Barbara Resnick, PhD, CRNP, professor of gerontology and Sonya Ziporkin Gershowitz chair of gerontology at the University of Maryland School of Nursing. "A lot of people don't want to admit they are not checking their glucose levels," she says. "If you cannot adhere to your self-care regimen, be honest. Talk to your provider about it so you can work out a system that's realistic for you."
It's also important to let health care providers know about any changes your body is going through, no matter how small, says Andrew Goldberg, MD, who heads the Division of Gerontology and Geriatric Medicine at the University of Maryland School of Medicine and the National Institutes of Health–funded Claude D. Pepper Older Americans Independence Center. "For example, tell your doctor if you are feeling weak or fatigued or light-headed." Even the smallest change may be important to note for the health of a person with diabetes. "Pay attention to your body. When it doesn't seem right, ask about it," he says.
Read on for six common challenges of aging to discuss with your health care provider:
1. Vision Problems
More than 28 percent of adults over the age of 40 living with diabetes experience diabetic retinopathy, or damage to the small blood vessels in the retina that can result in loss of vision. As people age, vision can deteriorate even further, especially if blood glucose levels are uncontrolled. Cataracts, common in people with diabetes, can also contribute to poor vision.
Failing vision makes it more difficult to read the directions on medication, to see blood glucose numbers on a meter, and even to walk down stairs without falling, especially if reflexes have also slowed, Goldberg says.
2. Hearing Loss
Likewise, seniors may want to have their hearing checked and not fear telling their doctor if they need to have directions repeated, says Medha Munshi, MD, director of the Joslin Diabetes Center's Geriatric Diabetes Program and assistant professor of medicine at Harvard Medical School. "Otherwise, a lot of things can be lost in translation," she says.
3. Mastering New Technology
Though intended to make life simpler, new technology can actually make things more difficult for people who do not adapt well to changes in their medical devices or tasks. "Gone are the days of just checking your blood sugar levels," says Resnick. "Now you have machines that track and record levels over time, but for someone who doesn't know how to operate that technology, they may wonder: Is that my blood sugar level today or from seven days ago?"
She suggests getting equipment that is as simple as possible. And remember, it's OK to ask your provider to review with you how to use a device.
4. Taking Medication as Directed
New medications can be confusing to a person who has a routine. Older people may have multiple prescriptions to address a growing number of health problems, and it may be tough to remember when to take which medication—or how much.
Goldberg suggests that people set up reminders for themselves, such as placing sticky notes on medicine cabinets and using pill boxes with sections for time of day and day of the week. Keeping a card in your wallet that details each medication, including the dose, how often it is taken, and the pharmacy's phone number, is also a good idea, he says.
Munshi says she will adjust a patient's medication to fit his or her resources. For example, if a person has a caregiver available at a certain time of day, Munshi may prescribe a type of insulin that can be given at that time. If there is no one to help with daily injections and the patient is unable to give them, she may switch the person to medication that can be given once a week. "It might not be the best treatment for the disease," she says, "but it is the best treatment for this person."
5. Fine Motor Skill Troubles
Many people struggle with fine motor skills as they get older, which can be worsened by arthritis and vision problems and may make daily diabetes self-care—such as picking up a test strip, loading a syringe, and giving an injection—stressful.
Resnick suggests that patients who have trouble loading a syringe with insulin ask a caregiver to preload syringes once a day or once a week, so they are ready when needed. They may also consider using a preloaded insulin pen instead of a syringe.
Goldberg also advises that people with deteriorating motor skills not attempt to trim their own toenails, because they can easily cut themselves, inviting infection. "Use an emery board, file them down," he says. "Or go to a podiatrist for help."
6. Maintaining Activity
As people get older, aging joints can make it more painful to exercise. "Patients may move slower and find themselves short of breath," says Resnick. "These are all things they might take to mean they should not exercise as much." But, she says, they may need to exercise more in most cases—though check with your health care provider. That's because being sedentary will only make such problems worse.
Resnick asks people to "think about getting active all day long. Work it into the routine things you do. Do exercises during commercials while you watch TV. If you live in a small home and don't have space to move around, march in place for 10 minutes while doing the dishes."
Munshi notes that fear of falling can also discourage people from being active. She recommends gradually increasing physical activity levels, in a way that's suited to your situation and abilities. For example, if someone is barely moving at all except to get off the couch and go to the bathroom, she suggests beginning by walking around the apartment for five minutes before each meal. After a few weeks, it may be possible to increase the time to 10 minutes. She also recommends exercise pedals that can be placed at the foot of a chair if the person does not have access to an exercise bike. Those who live in apartment buildings can walk the hallways, she suggests.
People who live for a long time have already navigated many changes. Altering your diabetes care routine to focus on safety and being less stressful honors your experience, abilities, and quality of life.
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