The overall goal of management of diabetes in the elderly patients includes maintaining optimal glycemic control as well as managing the associated risk factors due to advanced age.
1 Educating about the disease: Studies have shown that patients who know their diseases well are able to manage it more properly than those who are not educated about the disease. This is especially very important in case of diabetes. Elderly patients may not be able to remember properly about their drugs and doses or may forget about the nutritional care. It is important to educate them as well as their primary care givers.
2. Preventing and Recognizing Hypoglycemia: The risk of hypoglycemia is much more in the older adults and the symptoms may be missed or confused and so the hypoglycemic episodes are not properly reported in the elderly patients. Even a mild hypoglycemia that caused dizziness may lead do major problems like a fall and resulting fracture that is very difficult to heal due to the age factor. Thus it is important to take care and prevent hypoglycemia to occur at the first place.
3. Care for Proper Nutrition: Senior patients with diabetes should always be helped by a proper dietitian for the nutrition care. They should be advised to take protein rich food as protein slows sugar absorption.
4. Choosing the Medications: It is important to consider different factors like weight, mobility, kidney function, risk of hypoglycemia, and other co-morbidity before prescribing a medication to an elderly diabetic patient.
Metformin may be the initial therapy for patients who do not have a renal impairment or severe heart failure.
A short acting sulfonylurea like glipizide may be used for patients who have contraindication for metformin.
Repaglinide a drug distinct from sulfonylureas maybe used in patients who are allergic to sulfonyureas and also it has possibly a lower risk of hypoglycemia.
Insulin is usually avoided to be used in older patients but sometimes if required a long acting insulin with one or two daily doses can be used after proper assessment and explanation to the care giver.
5. Monitoring Of Blood Glucose: Monitoring is necessary to achieve glycemic controls and prevent the complications. It is usually advised to monitor HbA1c levels twice in a year for elderly patients who are meeting the treatment goals and are stable. Blood glucose concentrations can also be checked regularly at home by the patient or the care giver.
6. Retinopathy: The prevalence of retinopathy increases with the increased duration of diabetes and regular eye examinations are extremely important for older diabetic patients. The eye examination not only screens for retinopathy but also checks for the cataract and glaucoma that is more common in diabetes as well as with aging.
7. Care for the Foot: The foot problems are at much higher risk in patients who are old and have diabetes. With advanced age neuropathy increases and the old patients do not take care of the feet as they used to take care at their younger age. It is recommended that older patients should have their feet examined at every visit.
8. Physical Activity: Although many elderly patients have limited physical activity due to many associated factors like lack of interest in exercise plans, arthritis, nerve damage or vision problems but the primary care physician can guide each individual for the proper physical activity and exercise program that may be helpful.
9. Preventing Osteoporosis and Fractures: Diabetes is a known risk factor for osteoporosis and appropriate majors should be taken to prevent the complications associated with it more so in the elderly patients.
10. Managing the Associated problems: Elderly patients with diabetes are more prone to suffer from depression, urinary incontinence , urinary tract infections, sudden falls and problems with taking the medicine. it is important for the primary care physician to take notice of all these and manage appropriately.