Diabetes in Older People

Diabetes is a serious disease, and it affects many older adults. People get diabetes when their blood glucose, also called blood sugar, is too high. The good news is that you can take steps to delay or prevent type 2 diabetes, which is the most common form of the disease to develop in older adults. If you already have diabetes, there are steps you can take to manage the condition and prevent diabetes-related health problems.

What Is Diabetes?

Our bodies turn a lot of the food we eat into sugar, called glucose, which gives us energy. To use glucose as energy, our body needs insulin, a hormone that helps glucose get into our cells. If you have diabetes, your body may not make enough insulin, may not use insulin in the right way, or both. That can cause too much glucose to stay in the blood, which can cause health problems over time. Your family doctor may refer you to a doctor who specializes in taking care of people with diabetes, called an endocrinologist. Often, your family doctor will work directly with you to manage your diabetes.

Types of Diabetes

There are two main kinds of diabetes.

• In Type 1 diabetes, the body does not make insulin. Although older adults can develop this type of diabetes, it begins most often in children and young adults, who then have diabetes for life.
• In Type 2 diabetes, the body does not make or use insulin well. It is the most common kind of diabetes. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of getting type 2 diabetes is higher if you are overweight, inactive, or have a family history of diabetes. Women with a history of gestational diabetes (a type of diabetes that develops during pregnancy) also have a greater chance of developing type 2 diabetes later in life.

Diabetes can affect many parts of your body. It’s important to manage diabetes because, over time, it can cause serious health problems like heart disease, stroke, kidney disease, eye problems, and nerve damage that may lead to amputation. Also, people with type 2 diabetes may be at greater risk for cancer and Alzheimer’s disease.

What Is Prediabetes?

Millions of older Americans have “prediabetes.” This means their glucose levels are higher than normal but not high enough to be called diabetes. People with prediabetes have a greater chance of developing type 2 diabetes and having a heart attack or stroke.

If you have prediabetes, there are things you can do to prevent or delay getting type 2 diabetes. Losing weight may help. Healthy eating and being physically active can make a big difference. Work with your doctor to set up a plan to help you make healthier food choices and get regular exercise. Get help with quitting smoking (if you smoke), because smokers are more likely than nonsmokers to develop type 2 diabetes. Make sure to ask how often you should have your glucose levels checked. Your doctor may also talk with you about taking medication to delay or prevent type 2 diabetes.

Symptoms of Type 2 Diabetes

Symptoms of type 2 diabetes may include feeling tired, increased hunger or thirst, losing weight without trying, urinating often, or having trouble with blurred vision. You may also get skin infections or heal slowly from cuts and bruises. Some people with type 2 diabetes may not realize they have it because symptoms often develop slowly and go unnoticed. Sometimes older adults dismiss these symptoms as “getting old,” but they can be signs of a serious problem. Talk with your doctor if you have any of these symptoms.

Tests for Diabetes

Doctors use several blood tests to help diagnose diabetes:

• Random plasma glucose test—given at any time during the day
• A1C test—given at any time during the day; shows your average glucose level for the past 3 months
• Fasting plasma glucose test—taken after you have gone without food for at least 8 hours
• Oral glucose tolerance test—taken after fasting overnight and then again 2 hours after having a sugary drink (This is not regularly given for type 2 diabetes).

Your doctor may want you to be tested for diabetes twice before making a diagnosis.

Managing Type 2 Diabetes

Many people with type 2 diabetes can manage their blood glucose levels with diet and exercise alone. Others may need diabetes pills or insulin injections, along with medicines to manage other conditions like high blood pressure and high cholesterol. Over time, a person with diabetes may need both lifestyle changes and medication.

Once you’ve been told you have diabetes, a healthcare team will work with you to create a diabetes management plan. Your plan will be based on your lifestyle, preferences, health goals, and other health conditions you have.

As part of your plan, your doctor may prescribe one or more medications. Other healthcare professionals may also be involved. For example, a diabetes educator may help you understand diabetes and provide support as you make lifestyle changes to manage your diabetes. A dietitian may help with meal planning. An exercise coach may help you become more physically active.

Your diabetes management plan will cover how to:

• Track your glucose levels. Very high glucose levels (called hyperglycemia) or very low glucose levels (called hypoglycemia) can be risky to your health. Your plan will show how often you should check your glucose and how often to get the A1C test. If you are managing your diabetes without taking insulin, you may not need to check your glucose as often.
• Make healthy food choices. The food you eat affects glucose levels, so it’s important to learn what’s best for you to eat, how much, and when. If you are overweight, work with your healthcare team to come up with a plan to lose weight.
• Be active. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help. 
• Take your medicines. You should take medicine as prescribed even when you feel good. Tell your doctor if you have any side effects or cannot afford your medicines. Also, let your doctor know if you have trouble taking your medicine or keeping track of your medication schedule.

Here are some ways to stay healthy with diabetes:

• Manage your blood pressure. Get your blood pressure checked often.
• Manage your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems.
• Stop smoking. Smoking raises your risk for many health problems, including heart attack and stroke.
• Have yearly eye exams. Finding and treating eye problems early may keep your eyes healthy.
• Check your kidneys yearly. Diabetes can affect your kidneys. Urine and blood tests will show if your kidneys are okay.
• Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you’re over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.
• Care for your teeth and gums. Brush your teeth and floss daily. Have your teeth and gums checked twice a year by a dentist to avoid serious problems.
• Protect your skin. Keep your skin clean and use skin softeners for dryness. Take care of minor cuts and bruises to prevent infections.
• Look at your feet. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can’t. If you have sores, blisters, breaks in the skin, infections, or build-up of calluses, see a foot doctor, called a podiatrist.
• Keep up with cancer screenings. Ask your doctor which screenings to get based on your age, gender, and other risk factors.
• Talk with your doctor about your concerns. If you think you might need help with your management plan, are depressed, are worried about your memory, or have any other concerns, talk with your doctor. There may be ways to help.

At least once a year, your healthcare team will assess how well you are managing your diabetes. Your management plan might need changes, or you may need more information and support. A change in health, such as a new diagnosis or complication, or a change in care, such as going home from the hospital, may also lead to changes to your diabetes management plan.

Help with Diabetes Costs

Medicare may pay to help you learn how to care for your diabetes. It may also help pay for diabetes tests, supplies, flu and pneumonia shots, special shoes, foot exams, eye tests, and meal planning. For more information about what Medicare covers, call 1-800-633-4227 (1-800-MEDICARE) or visit the Medicare website.

Learn about other ways to help pay for diabetes medications and supplies.

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For More Information About Diabetes

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 01, 2019