Diabetes in older adults
Living with Diabetes as an older adult
Certain health conditions can manifest in different ways as we age, and diabetes is one condition that must be handled differently for older adults.
Here, we are looking at the various considerations for diabetes in older people, the types to be aware of, why diabetes can be a bigger challenge for older adults, warning signs in older people, ways to minimise your risk of developing the condition, potential complications of diabetes as you age, how to manage diabetes at home, where to find additional support, and how a carer can help with the monitoring of diabetes.
At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about diabetes in older adults, we can help.
What is diabetes?
Diabetes is a chronic condition characterised by high levels of glucose in the blood. According to the World Health Organization, diabetes occurs either when the pancreas is not producing enough insulin (a hormone that regulates blood glucose) or when the body cannot effectively make use of the insulin it produces. Without proper insulin function, glucose accumulates in the bloodstream which can lead to a number of complications.
Diabetes is estimated to affect around 4.4 million adults in the UK, with around 1.2 million people thought to be potentially living with undiagnosed diabetes. Some of the symptoms can include increased thirst, frequent urination, fatigue and blurred vision. The condition can be managed through medication, diet, exercise and monitoring blood sugar levels to prevent any serious health issues, but uncontrolled diabetes can lead to hyperglycaemia, also known as raised blood glucose or raised blood sugar. Over time, this can result in damage to many of the body’s systems, leading to serious outcomes like blindness, kidney failure, strokes, heart attacks or lower limb amputation.
Older adults may find the condition presents different symptoms and complications, and could be harder to manage. For example, diabetes symptoms in older adults could include wounds taking longer to heal, dizziness or fainting due to blood sugar issues, headaches, tingling in the hands or feet due to nerve damage, gum issues, an increased appetite, or a dry mouth.
Are there different types of diabetes?
There are three variations of diabetes older adults should be aware of:
Type 1 diabetes
This type occurs when the body doesn’t produce enough insulin on its own, or produces none at all. Older people can develop type 1 diabetes, however it most often begins in childhood or young adulthood. This type of diabetes cannot be prevented, and will remain a health condition for the duration of the person’s life. Those with type 1 diabetes will need to take insulin every day in order to stay healthy.
Type 2 diabetes
This type occurs when the body cannot effectively use the insulin it produces on its own. This is the most common form, affecting over 95% of those with diabetes. The risk of developing type 2 diabetes as an adult is higher if a person is overweight, leads a largely sedentary lifestyle, has a family history of the condition, or has a history of gestational diabetes (which can occur during pregnancy). The risk of type 2 diabetes is also thought to be 2-4 times higher for those of Asian (including Indian, Pakistani and Bangladeshi) Chinese, Black African and Black Caribbean ethnicity. Those with type 2 diabetes may need to take insulin in order to maintain control of their blood sugar, change their diet, and/or take oral medication depending on their individual health.
Pre-diabetes
Pre-diabetes is a condition that occurs before type 2 diabetes develops, and can be considered a warning for those on the verge of type 2 diabetes. This happens when glucose levels are higher than normal in the body, but not yet high enough to be diagnosed as having type 2 diabetes. Those with pre-diabetes have a higher chance of developing type 2 diabetes, however they can still prevent or delay this through some of the lifestyle changes mentioned later in this article.
Studies show more and more people with type 1 diabetes are living into old age, however type 2 diabetes is the most common of the two, and is prevalent in older age groups.
Why is diabetes a bigger challenge for older adults?
Hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar) can be the result of unmanaged diabetes, and this can impact anyone with diabetes no matter what age they are. However, there are a number of reasons why older adults need to consider diabetes more carefully than other age groups. These include:
- A higher risk of developing type 2 diabetes – Studies show older adults have a higher risk of developing this condition due to a combination of increased insulin resistance and impaired pancreatic function that comes with age, with those aged 65+ years old showing the highest prevalence of diabetes of any age group.
- A delay in diagnosis – Diabetes is often more difficult to diagnose in older adults due to atypical symptoms and symptoms from co-occurring conditions creating confusion.
- Changes in metabolism – As people age, their metabolism changes which can negatively impact the regulation of blood sugar in the body.
- Co-occurring conditions – Older adults tend to have multiple health conditions that impact the management of diabetes due to additional medications that may interfere with glucose control.
- Further complications – Older adults who have had diabetes for many years are more likely to develop complications such as cardiovascular issues, neuropathy, vision problems and more.
- Cognitive decline – Older adults are more at risk of cognitive decline such as dementia, which can make managing diabetes themselves much more difficult, or impossible. Similarly, those with dementia have a higher risk of developing diabetes.
- Dexterity issues – Managing diabetes might mean taking glucose readings and using devices to do this, which can be much more difficult for older adults who suffer from issues with dexterity.
- Nutritional deficiencies – Older adults tend to have a reduced appetite, a higher risk of dehydration, and other food-related issues that can impact nutrition and make the management of diabetes more difficult. You can read more about appetite issues in our guide to handling appetite loss in older adults.
- Reduced awareness of warning signs – Anyone with diabetes needs to watch out for the warning signs of hyperglycaemia to avoid dangerous episodes of this, however older adults may find it more difficult to identify the warning signs as they can become less obvious with age.
- Sensory impairments – Older adults have a higher risk of sensory impairments. For example, almost 1 in 5 older adults with diabetes in the US report visual impairments.
What are the warning signs of diabetes in older people?
In people with diabetes, hypoglycaemia or hyperglycaemia are the issues to watch out for. These are sometimes referred to as a “hypo” or “hyper”, and can cause a number of unpleasant symptoms.
Hypers can occur in both type 1 and type 2 diabetes, but these can be far more severe and potentially life threatening for those on insulin. If your diabetes is managed by oral medication, the signs of this may be less severe, but continued long-term hyperglycaemia can increase the risk of organ damage, neuropathy, skin issues and eyesight damage.
The signs of hyperglycaemia (high blood sugar) in type 1 diabetes can include:
- Extreme thirst, or drinking a lot
- Frequent urination
- Losing a lot of weight very quickly without trying to
- A noticeable loss of energy, muscle weakness and tiredness
- A general feeling of being unwell
- Nausea and stomach pains
- Vision issues
- Poor concentration
- Frequent infections such as cystitis
- Confusion, drowsiness or losing consciousness (this is a sign of extremely high blood sugar levels, and can result in a diabetic coma – this should be considered a medical emergency)
The signs of hypoglycaemia (low blood sugar) can include:
- A racing pulse
- Cold sweats
- A pale complexion
- Headaches
- Extreme hunger
- Shivering, or feeling weak in the knees
- Feelings of restlessness, nervousness or anxiety
- Difficulty concentrating
- Confusion
The warning signs of diabetes issues in older people may be slightly different, so it is important to understand what each person’s individual signs may be. For older adults, this could also include slow wound healing, recurrent infections, and neuropathy symptoms such as tingling or numbness in the hands or feet.
How can an older person minimise their risk of developing diabetes?
There are some lifestyle modifications older adults can make to minimise their risk of developing type 2 diabetes. Many clinical trials have found that in those with a high risk of developing type 2 diabetes, this was able to be prevented or delayed by either lifestyle interventions or medication. Lifestyle modifications that could help include:
- Adopting a balanced diet that reduces sugar and processed foods as much as possible to control weight and blood sugar levels. Keep in mind that while whole foods like fruit and honey are healthy options, they should be consumed in moderation as they are high in fructose, which is a type of sugar. Before adjusting your diet you should always speak to your doctor for a more accurate picture of what you need and what you should cut from your diet.
- Maintaining an active lifestyle as much as possible within the boundaries of your mobility limitations. Regularly working to strengthen muscles and exercise your mobility can improve your insulin sensitivity as well as improving overall health. Again, it is always best to speak to your GP before starting any new exercise routine.
- Avoiding smoking and excessive alcohol consumption in order to improve health and reduce the risk of diabetes complications, as well as reducing the risk of developing the condition in the first place.
- Scheduling regular health check-ups to monitor your blood sugar levels, blood pressure, cholesterol and other biomarkers that could provide early indication of complications and allow plenty of time for intervention. It is also recommended those with diabetes have regular kidney checks with urine and blood tests, as the condition has been known to affect kidney function.
Are there further complications for older adults?
As we age, our risk of health complications increases, and this is the case especially for those with diabetes. Older adults with diabetes have a heightened risk of complications due to age-related changes, as well as the cumulative effects of diabetes. These include an increased risk for:
- Hypoglycaemia and hyperglycaemia
- Cardiovascular issues such as heart disease and stroke
- Kidney disease
- Neuropathy leading to foot ulcers (and amputation, in extreme cases)
- Retinopathy causing vision loss
- Cognitive decline and dementia
Diabetes in older adults has been linked to higher mortality rates, so diabetes complications can significantly impact the quality of life and independence of older adults, reaffirming the importance of proactive diabetes management.
Can you manage diabetes at home?
Yes. Older adults can effectively manage diabetes at home with proper education, support and resources, however as age-related changes take place and other health conditions impact things like mobility, dexterity, cognitive abilities and more, many older people struggle to manage their diabetes at home by themselves, and will need the help of a loved one of caregiver to continue to do this effectively.
Depending on the type of diabetes, managing this from home usually means monitoring blood sugar levels regularly using home glucose monitors that track fluctuations in levels. This can also advise on necessary medication adjustments.
If the person is on medication for diabetes, managing this condition will require adherence to medication schedules, including insulin injections or oral medications. Attending regular health check-ups to monitor diabetes is also an important part of diabetes care, as well as maintaining a healthy diet, managing weight, managing stress levels, and avoiding smoking – all of these changes can help to effectively manage diabetes, and in some cases a healthy lifestyle could help to put type 2 diabetes into remission, even for older adults.
Where can older people get additional support for diabetes?
Older adults who suspect they have symptoms of diabetes can speak to their GP to obtain information on the best ways to manage this condition. They may also advise on additional support in the form of local community health centres, diabetes education classes, support groups, counselling services, and more. Specialist diabetes care teams may also become involved, including dietitians, endocrinologists, and other experts in this field of medicine.
If you are caring for someone with diabetes and would like to find out more information, you will find lots of resources online, including helplines and educational materials tailored to older adults. Take a look at Diabetes UK, the International Diabetes Federation, or Diabetes.co.uk for more information.
How can a carer help to monitor diabetes?
Over time, older adults may find it more difficult to manage diabetes themselves due to physical or cognitive limitations. Diabetes monitoring is a form of complex care provided by professional caregivers, so if you have diabetes and think you need help monitoring and managing it, this can be arranged for you.
A carer can assist an older person in this area by:
- Helping establish and stick to routines for blood sugar testing, medication administration, meal planning and more
- Accompanying them to healthcare appointments, taking notes and asking questions to ensure they clearly understand the medical advice given
- Providing emotional support and encouragement for when frustrating symptoms arise
- Helping them to stay motivated to manage their condition effectively
- Encouraging them to maintain a healthy lifestyle by preparing nutritious meals and encouraging physical activity
If your loved one requires insulin therapy, our Home Instead Care Professionals are trained to the highest clinical standards and can help manage diabetes with the full support of your healthcare provider. They can check blood sugar, administer insulin, clean and maintain equipment, order stock, prepare healthy meals, supervise safe exercise, promptly respond to low or high blood sugar readings, and more. Enlisting the help of a trained carer can enhance independence, and reduce health complications and hospital admissions for older people living with diabetes.
If you are currently looking to put home diabetes monitoring in place for yourself or a loved one, our award-winning home care can offer the bespoke, person-centred care you need to feel confident managing diabetes from home. Reach out to your local Home Instead team to discuss your needs.
We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.
Michelle Tennant, Clinical Governance Lead
I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 4 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.