If you are over the age of 65, your risk of developing type 2 diabetes is higher. More than 20% of people diagnosed with the disease are 65 years of age or older. That’s more than any other age group.
Blood sugar targets for people over 65 are less stringent than for younger adults. Diabetes management plans may also vary.
This article looks at the challenges of managing diabetes after age 65, blood sugar goals, how to monitor blood sugar, and the benefits of dietary changes and medication.
Managing diabetes over age 65
Low blood sugar is called hypoglycemia. It is defined as a level below 70 mg/dL (milligrams per deciliter). Symptoms include:
- trembling, nervousness, or anxiety
- sweating and chills
- fatigue and weakness
- blurred vision
Hypoglycemia is common in older adults with diabetes. This can be due to other health problems, such as other chronic diseases, malnutrition, or multiple medications. The risk of diabetes complications increases with age.
Taking too many diabetes medications can also lead to hypoglycemia. Overtreatment is common in older adults.
People over 65 may be underestimating hypoglycemia, the researchers said. This may be because they don’t always have symptoms. Additionally, cognitive impairment may make it difficult to communicate symptoms with caregivers.
The American Diabetes Association recommends routine screening for type 2 diabetes every three years for everyone after age 35. You may need earlier or more frequent screening if symptoms develop, or if you have or develop risk factors such as high blood pressure or obesity.
blood sugar level
When you’re over 65, your diabetes goals are different from younger people. Having other health conditions and/or cognitive impairments can affect your blood sugar goals.
If you are healthy, you may be able to manage your diabetes as you did when you were younger. If you have other health problems, less strict management can help you avoid low blood sugar.
|other conditions||cognitive impairment||target HbA1C||fasting goals||bedtime goals|
|none or very little||None or slight||7.5% or less||90–130 mg/dL||90–150 mg/dL|
|many kinds of||mild to moderate||8% or less||90–150 mg/dL||100–180 mg/dL|
|advanced disease||moderate to severe||8%-9%||100–180 mg/dL||110–200 mg/dL|
monitor blood sugar
Regular monitoring of blood sugar is critical to diabetes management. You check your blood sugar with a device called a blood glucose meter.
First, you prick your fingertip with a small needle called a lancet. Then put a drop of blood on the test strip of the blood glucose meter. After a few seconds, you will get a number.
In general, blood sugar should be checked before meals and at bedtime. Your healthcare provider may want you to check more or less often.
Cognitive decline and chronic illness can make it difficult for you to follow your diabetes care plan. This can happen even if you manage it successfully over the years.
In these cases, your healthcare provider may:
- Prescribe lower doses of medication
- Involve your caregivers in monitoring
- Watch out for low blood sugar
Blood Glucose Levels: What’s Normal and What’s Not
Diabetes is managed differently when you are over 65. There is a greater risk of hypoglycemia. The management of blood sugar may be less stringent to deal with this condition. It is important to monitor blood sugar frequently.
Diet is also important for managing diabetes. Maintaining a healthy diet can be a challenge for some older adults.That’s because it’s common gastrointestinal tract (Digestive) problems put you at risk of malnutrition.
These issues may include:
- Dysphagia (hard to swallow)
- Indigestion and intestinal problems
- feeling full after eating very little
Keeping a food log can help you and your care team understand what nutritional issues you may have.
Dr. Bernstein’s Diabetic Diet Overview
medical nutrition therapy
Older adults may need to include medical nutrition therapy in their diabetes treatment plan. At that time, a registered dietitian will develop a nutrition plan based on your needs.
Some strategies might include:
- Add Supplements, Protein or Liquid Calorie Boosters to Maintain Weight
- Easing food restrictions
- Assist with food preparation, eating, grocery shopping, or monitoring your nutritional status
Prevent and manage diabetes complications
Diet and medication are two ways to treat diabetes. Get help if you have a medical condition that makes it difficult to control your diet. Consider medical nutrition therapy.
The medicines you take to help control your blood sugar may negatively affect other medicines or supplements you take.
Healthcare providers must balance effectiveness with the risk of hypoglycemia and drug interactions. They have a lot of medicines to choose from.
From diet to medication: treating type 2 diabetes
DPP4 inhibitors can reduce your risk of low blood sugar. Heart failure is a possible side effect of these drugs. If your kidneys are not functioning well, you will need a lower dose.
Such drugs include:
SGLT2 inhibitors may also reduce the risk of hypoglycemia. Some drugs in this class may be a good choice if you have heart disease. Side effects may include:
- renal impairment
- bone loss
- low blood pressure
Some SGLT2 inhibitors are:
GLP1 agonists are administered daily or weekly by injection. Examples of these drugs are:
The preparation of exenatide ER and abiglutide can be time-consuming. Possible side effects are:
- lose weight
- loss of appetite
Digestive effects, such as decreased appetite, contribute to a dangerous degree of weight loss in older adults.
New treatment options for diabetes
Health care providers have many drug options to choose from. They must weigh the pros and cons of each drug when considering your overall health and other medications you are taking.
Low blood sugar becomes more likely when you are over the age of 65. Blood sugar targets are more relaxed to help manage this risk. Frequent blood sugar checks can also help prevent it.
Diabetes is controlled with diet and medication. Managing your diet can become more difficult as you age and your health declines. Your healthcare provider may recommend medical nutrition therapy.
Many medications can help control diabetes. Your provider can choose the one that is safest for you based on your individual needs and health.
It is normal for your diabetes management to change as you age. Follow the treatment plan your healthcare provider has made for you. Keep in mind that your target numbers may be higher than those of other age groups.
If you need help managing your diabetes, speak up. Your care team will guide you and help you find the resources you need.
How to deal with hypoglycemia
We know eating healthy is the key to helping manage diabetes, but it’s not easy. Our free nutrition guide is here to help. Sign up and get your free copy!
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VigorTip Health uses only high-quality resources, including peer-reviewed research, to support the facts in our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable and trustworthy.
Centers for Disease Control and Prevention. 2020 National Diabetes Statistics Report.
American Diabetes Association. Hypoglycemia (low blood sugar).
Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in the elderly – a lesser known risk factor for frailty. Aging separator2015 Mar 10;6(2):156-67. doi: 10.14336/AD.2014.0330
National Institutes of Health, U.S. National Library of Medicine: Medline Plus. Hypoglycemia.
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care for Diabetes—2022. Diabetes Care. 2022;45(Supplement 1):S17-S38. doi: 10.2337/dc22-S002
Leung E, Wongrakpanich S, Munshi MN. Diabetes management in older adults. Diabetes spectrum2018 Aug;31(3):245-253. doi: 10.2337/ds18-0033
Centers for Disease Control and Prevention. Diabetes: Monitor your blood sugar.
Kirkman MS, Briscoe VJ, Clark N et al. diabetes in the elderly. Diabetes Care2012;35(12):2650-2664. doi: 10.2337/dc12-1801
Stanley K. Nutritional considerations for the growing number of older adults with diabetes. Diabetes spectrum2014 Feb;27(1):29-36. doi:10.2337/diaspect.27.1.29
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