Diabetes mellitus in older people: why it occurs and how to treat it. Diabetes mellitus in old age

Correct and timely.

Insulin resistance is not limited to older people. Today, young patients and children are often diagnosed. But this question is still most relevant for people over 55 years old. What is the reason for this feature, how to identify the primary causes of diabetes?

As clinical studies show, diabetes mellitus, in particular, occurs in the background (80% of diagnoses). There are secondary factors that also contribute to the development of the disease.

In particular, it is important to note a few:

In this condition, sugar exceeds 30 mmol/l (with the norm being less than 5), speech becomes slurred, and thoughts are inconsistent. Not only brain cells are destroyed, but also all internal organs.

It is extremely difficult to talk about treatment in this case. The doctor’s task is to save lives and improve the quality of life. Drug treatment SD is the only thing correct option, which allows you to stabilize your health, and then only maintain a normal state.

When it is possible to stabilize sugar levels, it is recommended to use increatins (mimetics, GLP-1). But, in any case, it is worth understanding that the quality of life depends on the patient’s initial condition, and many therapeutic measures are aimed at reducing sugar. In the future, the patient only monitors, accepting the recommendations of his doctor.

Frequently prescribed drugs:

Diabetes is a disease that occurs against the background of disturbances in endocrine system. It is characterized by chronic high blood sugar levels. The disease is diagnosed at any age, but most often it affects people after 40 years of age.

The peculiarities of diabetes mellitus in older people are that its course is often unstable and mild. But characteristic feature diseases are excess weight, which more than half of pensioners have.

Since there are a lot of health problems in old age, few people pay attention to obesity. However, despite the long and hidden course of the disease, its consequences can be fatal.

There are two types of diabetes:

1. The first type develops with insulin deficiency. Often diagnosed in at a young age. This is insulin-dependent diabetes, which occurs in severe form. In this case, lack of treatment leads to diabetic coma and the diabetic may die.
2. The second type appears when there is an excess of insulin in the blood, but even this amount of hormone is not enough to normalize glucose levels. This type of disease mainly occurs after 40 years of age.

Since type 2 diabetes mainly occurs in older patients, it is worth considering the causes, symptoms and treatment of this type of disease in more detail.

Provoking factors and causes of development

From the age of fifty, most people experience decreased glucose tolerance. Moreover, when a person ages, every 10 years the concentration of sugar in the blood in the morning will increase, and after eating it will increase. So, for example, you need to know what .

However, the risk of diabetes is determined not only by age characteristics, but also the level physical activity and daily diet.

Why do old people develop postprandial glycemia? This is due to the influence of a number of factors:

• age-related decrease in insulin sensitivity in tissues;
• weakening of the action and secretion of incretin hormones in old age;
• insufficient production of insulin by the pancreas.

Diabetes mellitus in elderly and old age due to hereditary predisposition. The second factor contributing to the onset of the disease is considered to be excess weight.

Problems in the functioning of the pancreas also lead to pathology. These may be malfunctions of the endocrine glands, cancer or pancreatitis.

Even senile diabetes can develop against the background viral infections. Such diseases include influenza, rubella, hepatitis, chicken pox and others.

In addition, endocrine disorders often appear after nervous stress. After all, according to statistics, old age, accompanied by emotional experiences, not only increases the likelihood of type 2 diabetes in older people, but also complicates its course.

Moreover, in patients engaged in intellectual work, high level glucose levels are observed much more often than in those whose work involves physical activity.

Clinical picture and complications

Sugar level

Common symptoms of diabetes in people over 40 are:

1. weakened vision;
2. itching and drying of the skin;
3. convulsions;
4. constant thirst;
5. swelling of the lower extremities;
6. frequent urination.

However, all signs do not need to be present to confirm the diagnosis. The occurrence of 1 or 2 symptoms is enough.

Type 2 diabetes mellitus in patients retirement age often manifests itself as severe visual impairment, thirst, malaise and long wound healing.

Old age is dangerous due to frequent disorders in cardiovascular system aggravated by diabetes. Thus, patients often develop atherosclerosis of the coronary arteries, which affects the vessels of the legs, which can cause the development. And this leads to massive lesions of the foot and its further amputation.

Common complications of diabetes are:

• formation of abscesses;
• blurred vision (cataracts, retinopathy);
• heartache;
• swelling;
• infectious diseases of the urinary tract.

One more dangerous consequence diabetes is kidney failure. In addition, the nervous system may be affected, leading to neuropathy.

This condition is characterized by symptoms such as pain, burning in the legs and loss of sensation.

Diagnosis and drug treatment

Diabetes mellitus in older people is quite difficult to diagnose. This is explained by the fact that even when the blood glucose level is elevated, there may be no sugar at all in the urine.

Therefore, old age obliges a person to be examined every year, especially if he is concerned about atherosclerosis, hypertension, coronary artery disease, nephropathy and purulent skin diseases. The presence of hyperglycemia can be determined by indicators of 6.1-6.9 mmol/l, and impaired glucose tolerance is indicated by results of 7.8-11.1 mmol/l.

However, test answers for glucose tolerance may not be accurate. This is explained by the fact that with age, the sensitivity of cells to sugar decreases, and its level in the blood remains elevated for a long time.

Moreover, diagnosing coma in this condition is also difficult, since its symptoms are similar to the symptoms of lung damage, heart failure and ketoacidosis.

All this often leads to diabetes being detected at a late stage. Therefore, people over 45 years of age need to be tested for blood glucose levels every two years.

Treating diabetes in older patients is a rather difficult task, because they already have other chronic diseases and excess weight. Therefore, to normalize the condition, the doctor prescribes the patient a lot of different drugs from different groups.

Drug therapy for elderly diabetics involves taking such types of medications as:

1. Metformin;
2. glitazones;
3. sulfonylurea derivatives;
4. glinides;
5. gliptins.

Elevated sugar is most often reduced with Metformin (Clucophage, Siofor). However, it is prescribed only when the kidneys have sufficient filtration functionality and when there are no diseases that cause hypoxia. The advantages of the drug are the activation of metabolic processes, and it does not deplete the pancreas and does not contribute to the occurrence of hypoglycemia.

Glitazones, like Metformin, can increase the sensitivity of fat cells, muscles and liver to insulin. However, when the pancreas is depleted, the use of thiazolidinediones is pointless.

Also, glitazones are contraindicated for heart and kidney problems. Moreover, drugs from this group are dangerous because they contribute to the leaching of calcium from bones. Although such drugs do not increase the risk of developing hypoglycemia.

Sulfonylurea derivatives act on the beta cells of the pancreas, which is why they begin to actively produce insulin. The use of such drugs is possible until the pancreas is depleted.

But sulfonylurea derivatives lead to a number of negative consequences:

• increased likelihood of hypoglycemia;
• absolute and irreversible depletion of the pancreas;
• weight gain.

In many cases, patients begin to take sulfonylurea derivatives, despite all the risks, only to avoid resorting to insulin therapy. However, such actions are harmful to health, especially if the patient’s age reaches 80 years.

Glinides or meglitinides, as well as sulfonylurea derivatives, activate insulin production. If you take the drugs before meals, the duration of their effects after taking them is from 30 to 90 minutes.

Contraindications to the use of meglitinides are similar to those of sulfonylurea derivatives. The advantage of such remedies is that they can quickly lower blood sugar levels after eating food.

Gliptins, particularly Glucagon-like peptide-1, are incretin hormones. Dipeptidyl peptidase-4 inhibitors cause the pancreas to produce insulin while inhibiting the release of glucagon.

However, GLP-1 is only effective when blood sugar is truly elevated. Gliptins include Saxagliptin, Sitagliptin and Vildagliptin.

These agents neutralize a substance that has a destructive effect on GLP-1. After taking such drugs, the level of the hormone in the blood increases almost 2 times. As a result, the pancreas is stimulated, which begins to actively produce insulin.

Diet therapy and preventive measures

Diabetes mellitus in old age requires adherence to a certain diet. The main goal of the diet is to lose weight. To reduce the intake of fats in the body, a person needs to switch to a low-calorie diet.

So, the patient should enrich the diet fresh vegetables, fruits, lean meats and fish, fermented milk products, cereals and cereals. And you should avoid sweets, baked goods, butter, rich broths, chips, pickles, smoked foods, alcoholic and sweet carbonated drinks.

Also, a diet for diabetes involves eating small portions at least 5 times a day. And dinner should be 2 hours before bedtime.

Physical activity - good prevention development of diabetes in pensioners. With regular exercise you can achieve the following results:

1. reduce blood pressure levels;
2. prevent the appearance of atherosclerosis;
3. improve the sensitivity of body tissues to insulin.

However, the loads should be selected depending on the patient’s well-being and his individual characteristics. The ideal option would be to walk for 30-60 minutes. fresh air, swimming and cycling. You can also do morning exercises or do special gymnastics.

But for elderly patients there are a number of contraindications to physical activity. These include severe renal failure, unsatisfactory compensation of diabetes, proliferative stage of retinopathy, unstable angina and ketoacidosis.

Sugar testing is often prescribed by doctors when certain health problems arise. Traditionally, this indicator is the main medical criterion for diabetes mellitus.

More correct name research – glucose level determination. But the popular phrase It is also widely used by medical professionals and ordinary people.

What are the normal blood sugar levels?

The generally accepted indicators of a healthy person today for fasting measurements are 3.3-5.5 mmol for capillary blood. All healthy people should have this value. Wherein normal blood sugar in women, men and children are considered the same.

Test results taken from a vein will be considered normal if they are 12% higher than the suggested values. But not more. Here, the criterion for diabetes mellitus will be an increase above 7 before breakfast. Diagnosed at a value of 6.1-6.9.

However, different sources offer slightly different reference values. First of all, we are talking about age gradation. Western scientists seriously claim that for older people (over 60 years of age), blood glucose levels without breakfast and after a meal may be slightly higher than for children and young people.

Endocrinologists sometimes share these views, somewhat overestimating the indicators acceptable for their older patients. But for blood sugar levels in pregnant women, on the contrary, are set somewhat lower than generally accepted figures. Thus, the acceptable interval is often considered to be a fasting glucose level of no higher than 5.1 mmol when collecting material from a finger.

After eating, the blood sugar level changes. In case of accidental collection of material at any time during the day normal level a value below 7.8 mmol is considered. But diabetes mellitus can be reliably diagnosed only with values ​​above 11.1.

Of course, such indicators almost never occur in healthy people. Most likely, there is a violation of tolerance. However, this fact is only an indication for further research. To exclude further development of hyperglycemia. After all, the reasons for the increase in glucose levels can be of a different nature. Therefore, it is extremely important to understand and properly prepare for donating blood for sugar (read more about the rules of preparation).

Blood sugar levels by age

Normal numbers for capillary blood are given. Venous blood and plasma values ​​will be 12% higher, respectively. Gender does not matter.

• Infants up to 1 month – 2.8-4.4 mmol
• Children from 1 month - 14 - acceptable numbers are 3.3-5.6
• Age 14-60 – optimal glycemia is 4.1-5.9
• Age 60-90 years - focus on indicators of 4.6-6.4
• Over 90 years old – 4.2-6.7

Which analysis is the most accurate?

Another important question that worries all people with suspected or already identified carbohydrate metabolism disorders. Traditionally, many laboratories use the express method, i.e. check the indicator using a glucometer.

There is nothing strange here. The method is undoubtedly convenient and gives instant results. Only accuracy sometimes fails. Portable devices are designed to monitor glucose levels, but doctors rarely decide to use their readings as a basis for making a diagnosis.

More accurate and informative is laboratory analysis venous blood. It is needed for reliable determination of glucose, as well as for monitoring diabetes compensation. Endocrinologists advise periodically using the services of a laboratory, even if you have a home glucometer.

Another important point, changing the accuracy of the results – proper preparation to analysis. Sometimes even unnecessary excitement the day before or a large feast can significantly distort the true picture.

After 50 years for each subsequent 10 years:

Fasting glycemia increases by 0.055 mmol/l

Glycemia 2 hours after eating increases by 0.5 mmol/l

Features of the diabetes clinic in the elderly

Asymptomatic

The predominance of nonspecific complaints (weakness, fatigue, dizziness, memory impairment and other cognitive dysfunctions)

Diabetes is detected by chance during examination for another concomitant disease

Clinical picture of micro- and macroangiopathies at the time of diagnosis of diabetes

Presence of multiple organ pathology

The diagnosis of type 2 diabetes is made simultaneously with the identification of late vascular complications

Impaired recognition of hypoglycemia

Atypical laboratory diagnostic indicators

Absence of hyperglycemia on an empty stomach in 60% of patients;

The predominance of isolated postprandial hyperglycemia in 50–70% of patients;

Increasing renal threshold for glucose excretion with age.

Psychosocial

Social isolation

Low material capabilities

Impaired cognitive functions (decreased memory, learning ability, etc.)

Treatment goals for older patients with type 2 diabetes depend on:

Average life expectancy of the patient;

Conditions of the cardiovascular system;

Risk of hypoglycemic conditions;

Preservation of cognitive functions;

General somatic status;

Ability to conduct regular self-monitoring of glycemia.

Criteria for optimal compensation of type 2 diabetes in old age and/or with a life expectancy of less than 5 years

Principles of diabetes treatment

1. Insulin therapy (for health reasons) for type 1 diabetes, insulin therapy or PSSP drugs for type 2;

2. Physiological individualized diet;

3. Physical activity;

4. Training;

5. Self-control;

6. Prevention and treatment of late complications of diabetes;

7. Psychological assistance.

Diet for diabetes - physiological balanced with normal ratio of proteins, fats and carbohydrates. The ratio of the main ingredients in the daily diet: 50-60% of the total calorie content of food is covered by carbohydrates, 25-30% by fats and 15-20% by proteins.

Nutrition should be regulated in terms of total caloric content, the number of its components and meal times

For normal body weight, the diet is isocaloric. In case of severe weight loss (type 1 diabetes, decompensation), a hypercaloric diet may be recommended

Energy expenditure in the body is determined by energy expenditure at rest (basal energy balance) and depends on the patient’s phenotype.

For diabetes, it is recommended to eat 5-6 times a day, which allows you to more adequately model the level of insulin and glucose in the blood in accordance with those indicators that occur in a healthy person.

A diet, especially for type 1 diabetes, involves calculating CA (calorie equivalents), which is necessary to determine the dose of insulin administered before each meal. In general, this is important for intensified insulin therapy. Special calculation tables have been developed with which you can determine the amount of carbohydrates in XE, the amount of one product, and determine possible replacements.

The need for insulin per 1 XE may vary depending on the patient’s condition (addition of intercurrent diseases, presence or absence of compensation), as well as age. Early in the morning 1 XE - 2 units of insulin; at lunch – 1.5 units of insulin; dinner – 1 unit of insulin.

Diabetes mellitus is a very dangerous and insidious disease. The first symptoms of diabetes mellitus, people may confuse it with a slight illness, the action infectious disease. For many people, diabetes can be silent. As a preventative measure, it is necessary to check your blood sugar levels every six months, this will help detect the disease in early stage, especially people who are at risk. Glucose levels can also be measured at home, for example, using a special device called a glucometer. A blood test in a clinic is usually taken from a finger, but can also be taken from a vein. At home, a glucometer can determine the level from a drop of blood.

Within 5 seconds, the device will show the exact result. If a glucometer test shows a deviation in your sugar level from the norm, you need to take a blood test from a vein at the clinic, as directed by your doctor. This way you can find out whether you have diabetes or not.

For getting reliable results tests must measure blood glucose levels strictly on an empty stomach for several days. It is best to examine blood from a vein and finger in the laboratory of a medical institution.

Some men and women make the mistake of suddenly changing their diet before the analysis, starting to eat right, or “going on a diet.”

You can't do that!

This leads to the fact that the true state of affairs with the pancreas is hidden and it will be more difficult for the doctor to make an accurate diagnosis. When taking tests for sugar, take into account your emotional state and other factors.

Fatigue, pregnancy, chronic diseases, all this can significantly affect glucose levels and their deviation from the norm. It is not recommended for men and women who will take tests, work at night, or go to bed late. Before the test, you must first get a good night's sleep.

Video: Diabetes. Three early signs

Remember!

In a healthy person, blood sugar levels are always measured on an empty stomach, with the exception of clarifying tests, when blood can be taken after a meal.

Men and women who are over 40 years old should be tested for sugar, as they are at risk.

In addition, women during pregnancy, as well as overweight people, need to monitor their blood sugar levels.

Table of blood sugar norms for women by age

The sugar intake for women and men is basically the same, but there are differences.

The result will depend on some parameters:

1. The test was taken on an empty stomach or after eating
2. Sugar levels change with age; after 60 years, the level may increase in women and men

If a person eats normally, he leads active image life, does not abuse alcohol, is not a drug addict, and the analysis shows elevated glucose levels, then the patient can be suspected of developing diabetes mellitus.

The unit of measurement for this blood parameter is millimoles per 1 liter of blood (mmol/l). An alternative unit is milligram per deciliter of blood mg/100 ml (mg/dL). For reference: 1 mmol/l corresponds to 18 mg/dl.

Normal glucose levels depend on the age of the patients.

Regardless of gender, both men and women should always take care of their health and monitor their sugar levels, undergoing professional tests on time. examinations, blood and urine tests.

Sugar levels in older women

Check your blood sugar levels!

This is especially true for blood sugar levels in women after 40 - 50 - 60 - 70 years of age.

Typically, in elderly women, glucose levels rise exactly two hours after eating, and fasting glucose remains near normal.

Reasons for increased blood sugar levels in women

This phenomenon has several causes that act synchronously on the body.

Firstly, it is a decrease in the sensitivity of tissues to the hormone insulin, a decrease in its production by the pancreas. In addition, in these patients the secretion and action of incretins weakens. Incretins are special hormones that are produced in the digestive tract in response to food intake. Incretins also activate the production of insulin by the pancreas. With age, the susceptibility of beta cells decreases several times, this is one of the mechanisms of diabetes development, no less important than insulin resistance. Due to their difficult financial situation, older people are forced to grub on cheap, high-calorie foods.

Such food contains: an extraordinary amount of quickly digestible industrial fats and light carbohydrates; lack of complex carbohydrates, protein, fiber.

The second reason for increased blood sugar in old age is the presence of chronic concomitant diseases, treatment with potent drugs that have a detrimental effect on carbohydrate metabolism.

The most risky from this point of view are: psychotropic drugs, steroids, thiazide diuretics, non-selective beta blockers. They can cause the development of disturbances in the functioning of the heart, lungs, and musculoskeletal system.

Causes of hyperglycemia

The sugar limit may be exceeded due to:

• Due to junk food, when a person abuses sweets
• alcohol abuse, smoking
• due to nervous tension, stress
• due to increased activity of the thyroid gland and other endocrine diseases
• diseases of the kidneys, pancreas and liver.

Blood glucose levels can sometimes increase after taking steroids, diuretics, or some birth control pills. Women's sugar levels increase during pregnancy.

When the test shows elevated glucose levels (hyperglycemia), the patient is next given 200 ml of water with sugar to drink, and tested again 2 hours later. It happens that a person’s blood glucose level can rise due to the fact that he ate a sweet apple.

Symptoms of hyperglycemia in men and women:

• thirst
• dry mouth
• skin problems, severe itching
• the patient suddenly loses weight
• blurred vision
• Frequent painful urination bothers you
• difficulty breathing, it becomes loud and uneven

For women over 60 years of age, type II diabetes mellitus, defined as benign, is most common. It mainly occurs in a trivial form and is not characterized by pronounced symptoms. Moreover, a significant proportion of older women do not even suspect that they have the disease, which is why it is diagnosed late and most often by coincidence.

A distinctive feature that can lead a doctor to believe that his elderly patient has diabetes mellitus is that she is obese, which indicates disturbances in the process of lipid metabolism.
Between the onset of the development of the disease and the formulation of a systematic diagnosis, years would pass, during which the elderly madam would experience the torment of erased symptoms arising from time to time, but would not turn to a medical professional.

The classic symptoms accompanying diabetes in the elderly are:

• pathology of sensitivity in the limbs;
• the appearance of pustules on skin;
• decreased visual acuity;
• the appearance of pain in the heart area;
• swelling of the face and neck;
• development of various fungal disorders, etc.

In the interests of older women, the development of trophic changes in the limbs and the appearance of signs of “diabetic foot” are also inherent. Trophic changes develop due to the effect of glucose on the blood walls.

For older representatives of the fairer sex, the development of an unexpected and dangerous diabetic coma is also common. Usually, a suddenly developed coma caused by a high level of glucose in the blood ends in death, if we are talking about elderly people.

In more than half of the people whose analysis showed an increase in blood sugar, latent pancreatitis (inflammation of the pancreas) was detected. The insidiousness of the disease is that the symptoms of pancreatitis may not give obvious signs, masquerade as other diseases and gradually destroy pancreatic tissue.

How to lower blood glucose levels

Helps significantly reduce sugar levels balanced diet and diets. It is important to follow a diet for those who have already been diagnosed increased level blood glucose. Eliminate from your diet: animal fats, sweets, fast foods, juices, bananas, persimmons, figs, sweet sodas, alcohol.

To normalize metabolism in the future, in order to maintain normal gluco levels, it is necessary to include in the menu: seafood, fish, beef, rabbit meat, vegetables, herbal teas, mineral water.

Video: Diabetes mellitus in older people

Why is diabetes so dangerous for older women?

The reason is that patients tolerate cardiovascular complications unusually poorly and have every chance of dying from a stroke, heart attack, blockage of blood vessels by a blood clot, or acute heart failure.

There is also the possibility of remaining incapacitated and disabled when irreparable brain damage occurs.

A similar complication can occur at a young age, but it is very difficult for a much older person to tolerate it. When a woman’s blood sugar level rises quite often and unpredictably, this becomes the basis for falls and injuries.

Insulin is known as a hormone of the pancreas. When glucose concentration rises, the pancreas increases insulin secretion. In the case when there is no insulin, or there is not enough of it, glucose does not begin to transform into fat. If you accumulate a large number of glucose in the blood, diabetes develops.

At this moment, the brain can begin to actively use excess glucose, partially ridding us of excess fat.

Over time, sugar can be stored in the liver (fatty liver). It is also dangerous when large amounts of sugar begin to interact with skin collagen, which is necessary for the smoothness and elasticity of our skin.

Gradually, collagen is disrupted, which leads to aging of the skin and the appearance of premature wrinkles.

Elevated glucose levels can lead to vitamin B deficiency. In general, vitamins and minerals are poorly absorbed by the body in diabetes mellitus.

High blood sugar speeds up metabolism, causing people to develop problems with their kidneys, heart, and lungs.

Sugar gradually destroys the immune system, a person is exposed to more and more infections and viral diseases, and the body loses the ability to effectively fight infection.

Thus, in both older women and men, increased glucose levels are quite common.

In order to prevent the development of diabetes, you have time to pay attention to changes in indicators in the analysis and take appropriate measures. To prevent the disease, it is important to adhere to a diet and healthy image life.

Video: normal blood sugar in women, table by age

It is important to understand that usually the blood glucose levels in women and men have the same normal values. The level may vary depending on age, the presence of a particular disease and female characteristics body. Blood sugar levels may also be affected by the time of the test and the conditions observed..