Managing diabetes in older adults

Diabetes is a rising health problem in the UK. There are now around 5.6 million people in the UK diagnosed with diabetes, twice as many as in 1996.

Diabetes is caused by issues with a hormone called insulin. Insulin is created in the pancreas and is responsible for converting sugars from food and drink into glucose, which is used for energy. If a person cannot produce enough insulin to convert these sugars, they go into the blood stream, causing high blood sugar.

There are several types of diabetes:

• Type 1 diabetes accounts for 8% of diabetes cases in the UK and is usually diagnosed earlier in life. It is when the body cannot produce enough insulin to regulate blood sugar because the immune system attacks the cells that create it. People with Type 1 diabetes must inject insulin throughout their lives.
• Type 2 diabetes accounts for 90% of diabetes cases in the UK and is usually diagnosed in middle or late life. It is when the body cannot produce enough insulin and/or the insulin cannot work effectively enough to regulate sugars from food and drink. It is often a result of lifestyle factors, such as a diet high in sugar and lack of exercise.
• The remaining 2% includes people with rarer forms of diabetes, such as gestational diabetes (that happens during pregnancy) and monogenic diabetes.

Why is diabetes more common in older adults?

Diabetes is more common in older adults because as the body gets older the pancreas produces less insulin or becomes increasingly insulin resistant, so cannot process sugars into glucose as effectively.

According to the NHS, just 1% of adults in the UK aged under 35 is diagnosed with diabetes, rising steadily to 16% of people aged over 75.

In previous studies this figure drops for those over 85, which may be due largely to the fact that diabetes reduces life expectancy by an average of 10 years.

Diabetes UK estimates that there are around 13,500 care home residents living with undiagnosed diabetes.

What are the risk factors of diabetes in older adults?

Diabetes can be more challenging for older people than younger people, particularly due to diabetes’ links to other health conditions more common in old age and the person’s ability to care for themselves.

Diabetes can indirectly increase risk of dementia

There is little evidence for a direct causal link between diabetes and dementia. However, diabetes can cause issues with blood flow to the brain.

Diabetes can damage blood vessels, including those that supply blood and the essential oxygen and nutrients it carries to the brain. This can increase the risk of vascular dementia, as well as stroke.

It is also common (though not a rule) that people living with Type 2 diabetes have sedentary lifestyles and diets high in sugar. These are lifestyle factors that can increase your risk of developing dementia.

Higher risk of diabetes-related illness

Diabetes can increase a person’s risk of stroke, heart disease, kidney disease and peripheral arterial disease, all of which count age as a risk factor in themselves.

This means that living with diabetes can make an older person more likely to experience additional health complications.

Older bodies can also be less tolerant of medical treatments, and it can be challenging to treat multiple chronic conditions.

Effects of diabetes can worsen or accelerate problems already related to old age

Diabetes comes with a host of physical health complications that are already more likely to affect older people.

Issues like poor vision, malnutrition and mobility problems are prevalent in older age, but are also effects of living with diabetes. In more severe or untreated cases, people living with diabetes can develop peripheral arterial disease, ulcers that won’t heal (which can lead to amputation) or blindness.

These effects can significantly reduce independence and quality of life, particularly if the person already experiences frailty.

Diabetes is a notifiable condition when it comes to driving, meaning a person diagnosed with the condition must tell the DVLA/DVA about it. While this is essential for the safety of the person and other road users, it can be a further detriment to an older person’s independence if they are deemed not safe to drive.

Diabetes in care homes

Older people can find it more challenging to look after themselves and manage their diabetes. Older people often require care and support with daily living, and additional care for their diabetes presents extra challenges.

When a person moves into a care home or starts receiving home care, a care plan will be drawn up. This details the person’s health conditions and support needs and plans how their care will be delivered.

For people who live with diabetes, their care plan might include:

• Diet management to ensure that the person has a healthy and balanced diet that is low in sugar and salt.
• Support to exercise, through 1:1 support and/or in group exercise activities with other care home residents or local groups.
• A record of the medication they need to take, when and how it needs to be administered and support to take it. If the person needs insulin injections, these may be administered by a Registered Nurse.
• Plan for regular blood glucose testing.
• Support to attend medical appointments.
• Care for diabetic ulcers (these may require nursing care).
• Bariatric care.

Helplines

Diabetes UK

Website: Diabetes UK – Know diabetes. Fight diabetes.

Helpline (England, Wales, Northern Ireland): 0345 123 2399
Email (England, Wales, Northern Ireland): helpline@diabetes.org.uk

Helpline (Scotland): 0141 212 8710
Email (Scotland): helpline.scotland@diabetes.org.uk

Diabetes.co.uk

Website: Diabetes Community, Support, Education, Recipes & Resources
Telephone: 0330 1330 307

Silverline

24-hour telephone support for older people

Website: The Silver Line Helpline
Helpline: 0800 4 70 80 90