Diabetes is a serious disease, and it affects many older adults. People develop diabetes when blood glucose, also known as blood sugar, is too high. The good news is that there are steps a person can take to delay or prevent type 2 diabetes, which is the most common form of the disease that develops 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 the diabetes?

The body transforms many of the food we eat into sugar, called glucose, and this provides us with energy. To use glucose for energy, the body needs insulin, a hormone that helps glucose enter cells. If a patient has diabetes, their body may not make enough insulin, may not use insulin correctly, or both. That can cause too much glucose in the blood, which can lead to health problems over time. Your family doctor may refer you to a doctor who specializes in the care of patients with diabetes, called an endocrinologist. Often times, the family doctor will work directly with the patient to control the diabetes.

Types of diabetes

There are two main types of diabetes.

In type 1 diabetes, the body does not make insulin. Although older adults can develop this type of diabetes, it most often begins in children and young adults, who then have lifelong diabetes.

In type 2 diabetes, the body does not make or use insulin well and it is the most common type of diabetes. It occurs most often in middle-aged and older adults, but it can also affect children. The chance of having type 2 diabetes is higher if the person is overweight, inactive, or has a family history of diabetes. Women with a history of gestational diabetes (a type of diabetes that develops during pregnancy) also have a higher chance of developing type 2 diabetes later in life.

Diabetes can affect many parts of the body. It is important to manage diabetes because it can cause serious health problems over time, such as heart disease, stroke, kidney disease, eye problems, and nerve damage that can lead to amputations. Also, people with type 2 diabetes may be at higher risk of developing cancer and Alzheimer's disease.

What is prediabetes?

Millions of older people in the United States have "prediabetes." This means that glucose levels are higher than normal, but not high enough to diagnose them as diabetes. People with prediabetes are more likely to develop type 2 diabetes and have a heart attack or stroke.

If a patient has prediabetes, there are things you can do to prevent or delay type 2 diabetes. Losing weight can help, and eating healthy and staying physically active can make a big difference. The patient should work with the doctor to establish a plan to help them choose healthier foods and exercise regularly. Also, you should get help to quit smoking (if you smoke at all), because smokers are more likely than nonsmokers to develop type 2 diabetes. Be sure to ask how often your glucose levels should be checked. The doctor may also talk with the patient about taking medications to delay or prevent type 2 diabetes.

Symptoms of type 2 diabetes

Symptoms of type 2 diabetes can include feeling tired, being hungrier or thirsty, losing weight without trying, urinating frequently, or having vision problems such as blurred vision. People can also develop skin infections or heal very 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 because they consider them “part of aging,” but they can be signs of a serious problem. People should see their doctor if they have any of these symptoms.

Tests to detect diabetes

Doctors use several blood tests to help diagnose diabetes:

Random plasma glucose test — given any time of the day
A1C test — administered at any time of the day; indicates the average glucose concentration during the last 3 months
Fasting plasma glucose test — administered after the person has not eaten for a period of at least 8 hours
Oral glucose tolerance test — given after the person has fasted overnight and then again 2 hours after they have had a sugary drink (this test is not used regularly for type 2 diabetes).

Your doctor may want a diabetes test done twice before making a diagnosis.

Managing type 2 diabetes

Many people with type 2 diabetes can control their blood glucose levels with just diet and exercise. Others may need diabetes pills or insulin injections, along with medications to control other conditions such as high blood pressure and high cholesterol. Over time, a person with diabetes may need both lifestyle changes and medications.

Once diabetes has been diagnosed, a healthcare team will work with the patient to create a disease management plan. The plan will be based on the patient's lifestyle, preferences, health goals, and other health conditions.

As part of the plan, the doctor may prescribe one or more medications for the patient. Other health care professionals may also be involved. For example, a diabetes educator can help the patient understand the disease and provide support as they make lifestyle changes to manage their diabetes. A dietitian can help you with meal planning, and an exercise trainer can help you become more physically active.

Diabetes and brain health

If a patient has diabetes, the doctor can test them for depression or cognitive impairment. Older adults with diabetes are at higher risk for these conditions than other people their age who do not have diabetes. Having depression or cognitive decline can make diabetes self-care difficult.

The diabetes management plan will tell the patient how to:

Keep a record of glucose concentrations. Very high levels of glucose (known as hyperglycemia) or very low levels of glucose (known as hypoglycemia) can be dangerous to your health. The plan will state how often a patient should have their glucose level checked and how often the A1C test should be done. If you are managing diabetes without taking insulin, the patient may not have to check glucose as often.

Choose healthy foods. The foods a patient eats affect glucose levels, so it is important to know which foods are best, and how much and when to eat. If you are overweight, you should work with your health care team to develop a plan to help you lose weight.

Keep active. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. The patient should set a goal to be more active most days of the week and develop a plan to stay physically active that fits into his life and that he can stick to. Your healthcare team can help you.

Take your medications. The patient should take their medications as directed, even when they feel fine. You should tell your doctor if you have side effects or if you don't have money to pay for your medications, and also if you have trouble taking your medications or keeping your medication schedule correctly.

Here are some ways to stay healthy when you have diabetes:

Check blood pressure. Get frequent blood pressure checks.

Control cholesterol. At least once a year, have a blood test to check your cholesterol and triglyceride levels. High concentrations can increase your risk of developing heart problems.

Stop smoking. Smoking increases your risk of developing many health problems, including heart attacks and strokes.

Get yearly eye exams. Finding and treating eye problems early can help keep them healthy.

Get yearly kidney exams. Diabetes can affect the kidneys. Urine and blood tests will show if your kidneys are okay.

Get a flu shot every year and get a pneumonia shot. An annual flu shot will help you stay healthy. If you are over 65, make sure you have had the pneumonia vaccine. If you were under 65 when you got the pneumonia vaccine, ask your doctor if you may need another one.

Take care of your teeth and gums. Brush and floss your teeth every day. Visit the dentist twice a year to check your teeth and gums to avoid serious problems.

Protect your skin. Keep skin clean and use smoothing creams to avoid dryness. Take care of small cuts and bruises to prevent infection.

Check your feet. Take time to check your feet every day for reddened areas. Have someone check your feet if you can't. If you have sores, blisters, cuts on the skin, infections, or buildup of calluses, see a doctor who specializes in foot care, called a podiatrist.

Stay up-to-date with cancer screenings. Ask your doctor what screening tests you should have based on your age, gender, and other risk factors.

Talk to your doctor about your concerns. If you think you might need help with your management plan, are depressed, have concerns about your memory, or have any other concerns, talk to your doctor. There may be ways to help you.

At least once a year, your health care team will evaluate how well you are managing your diabetes. Your management plan may 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 medical care, such as going home after a hospital stay, can also cause changes in your diabetes management plan.

Be prepared

Make sure you always have at least a 3-day supply of supplies available to test and treat your diabetes in case of an emergency.

Help with the costs of diabetes

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

For more information:

American Diabetes Association
(American Diabetes Association)
800-342-2383 (toll free)
askada@diabetes.org
www.diabetes.org
www.diabetes.org/en

Centers for Disease Control and Prevention (Centers for Disease Control and Prevention)
800-232-4636 (toll free)
888-232-6348 (TTY / toll free)
cdcinfo@cdc.gov
www.cdc.gov
www.cdc.gov/spanish

National Institute of Diabetes and Digestive and Kidney Diseases (National Institute of Diabetes and Digestive and Kidney Diseases)
800-860-8747 (toll free)
866-569-1162 (TTY / toll free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov/health-information
www.niddk.nih.gov/health-information/health-information

The National Institute on Aging (NIA), part of the National Institutes of Health, provides the information in this document, which has been reviewed by its scientists and other experts to ensure that it is accurate. and is up to date.

Text revised on: May 23, 2019