Getting older doesn’t have to mean getting diabetes, but it does mean your risk increases. The majority of Americans with Type 2 diabetes are over 60, and rates rise sharply with age. While 11 percent of middle-aged adults have diabetes, it’s nearly 22 percent for seniors 65 and older, according to the Centers for Disease Control and Prevention.
The upside is, if you are diagnosed with diabetes or prediabetes, there are steps you can take and plenty of resources to help you stay as healthy as possible.
Exercise, exercise, exercise: That’s the best way keep prediabetes from progressing, says Linda Haas, a diabetes consultant in Seattle who specializes in gerontology. No need to become a mountaineer, Haas says: A double 20 minutes of brisk daily walking may turn prediabetes around.
A major U.S. study found exercise worked particularly well for adults age 60 and older, reducing their risk of moving on to diabetes by 71 percent. And if you have diabetes, exercise helps keep your blood sugar under control.
“Exercise and being active is one of the best things you can do for yourself, both psychologically and physically,” says Haas, a former president of the American Association of Diabetes Educators. One tip she often gives: Get a dog to guarantee daily walks for both of you.
Group or gym activities have an added perk – interaction with others, which wards off isolation. SilverSneakers, a gym-based fitness program for seniors, is covered by some insurers, including Medicare. Senior centers also have classes to keep people healthy and connected.
Devices from pedometers to Fitbit’s allow you to measure steps, gauge your progress and gradually build endurance.
Mind your muscles: As people age, their bodies change in several ways that contribute to diabetes. “People become more insulin-resistant so that their own insulin doesn’t work as well,” Haas says. With age and less activity, abdominal fat increases, waistlines can widen and sarcopenia, or muscle-wasting, can occur.
When patients reach 75 and older, age-related issues really come into play, says Dr. Medha Munshi, director of the geriatric diabetes program at Joslin Diabetes Center. Even frail seniors with diabetes benefit from increasing their activity, she says.
Plans are individualized, Munshi says. If someone tends to sit in a chair most of the day, she suggests becoming more active inside the home, to avoid anxiety about heat, rain and outdoor falls. “I would ask them to do five minutes of walking before each meal, inside,” Munshi says. “And build up from there.”
For seniors already walking a couple miles a day, she recommends adding resistance training to build up muscles and exercises to improve gait and balance.
With older adults with diabetes, less emphasis is placed on weight loss, unless the person is obese, with a BMI of 30 or more. “In geriatrics, we don’t like people to lose much weight,” Munshi says. “That loses muscle and fat, which is not necessarily good for them.”
Balance carbs: Munshi sympathizes with patients with previous conditions who are already doing their best to change their diet – reducing salt and fat for better heart health – and now have to adjust more. Having diabetes means being continually aware of carbs and their sharp effect on insulin and blood sugar.
Haas says with dietary carbs, it’s a matter of balance. Choose complex carbs over simple carbs, she advises. Also, avoid loading up on carbs for one meal and skipping them the next. Instead, keep levels steady.
“Folks run into trouble if one morning they have bacon and eggs – that’s no carbs. And the next morning they have cold cereal and fruit – that’s a lot of carbs,” Haas says. “It would be better to spread the carbs out. It puts less of a strain on the pancreas and the amount of insulin it has to make.”
Munshi suggests instead of drastically changing your diet, spread those carbs throughout your day. If you have oatmeal at breakfast, she says, save the half-bagel for a midmorning snack and the slice of toast for lunch, along with a salad.
Watch for low blood sugar: With certain diabetes drugs, low blood sugar, or hypoglycemia, is a concern. “If seniors are on a medication that can cause low blood sugar, like the sulfonylureas, or insulin, we want them to test more frequently,” Haas says.
That’s especially true if they live alone, she adds. As people age, they may be less likely to experience symptoms like sweatiness or shakiness that serve as warnings signs of low blood sugar.
If the shoe fits: Diabetes affects circulation, which poses hazards for feet, putting them at risk for nerve damage, infections, and ulcers. If unrecognized and untreated, neuropathies, or nerve damage to the feet and lower legs, can eventually result in amputation.
“The second most common cause of amputations is poorly fitting shoes,” Haas says. “How do we tell how our shoes fit? By how they feel.” People may not realize that shoes are rubbing or they’re getting a blister. For seniors who fit the criteria, an underused Medicare benefit is therapeutic shoes – one pair each year, plus three pairs of inserts.
See your doctor: In general, Haas says, patients on oral diabetes medications should see their healthcare providers every six months. Patients on insulin should return every three months. In addition, patients with neuropathies should have their feet examined every three months.
Keep up with vision checks: Even if it’s hard to keep up with preventive services, there are one exam seniors can’t skip, Munshi says: “They must see the eye doctor. Because eyes are important at any stage, any age, any quality of life.” She encourages yearly visits at a minimum.
Seek help: People with pre-existing diabetes who age into Medicare face new and unexpected gaps in coverage, says Melissa Lee, interim executive director of the Diabetes Hands Foundation, a nonprofit providing information, and support to people with diabetes and family members. Her group is part of the Diabetes Advocacy Alliance, which works to improve diabetes awareness and action among policymakers.
It’s a challenge to figure out which diabetes equipment, supplies, and medications are covered under Medicare – and whether these fall under Medicare Part B or Part D. “For seniors to understand it, they need an advocate,” Lee says. “They need an ally, someone to help them through.” The foundation’s online community is one source of peer advice.
The Medicare website walks patients through the coverage process, and you can download a booklet on Medicare-covered diabetes services and supplies. Diabetes education from a certified diabetes educator is another covered benefit, Haas notes.
Connect with others in your situation, Haas advises. The American Diabetes Association, which offers an extensive guide for seniors with diabetes, can direct you to local support groups.
Source: Lisa Esposito