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Dr. Rohi Shetty Dr. Rohi Shetty
Diabetes is principally a disease of the middle-aged and elderly; more than one in ten people over 65 suffer from diabetes. Often the elderly do not have access to information about diabetes and this affects their ability and willingness to follow advice about diet, exercise and medicines. Doctors often do not have time to counsel them fully. The following information about diabetes is presented in the question-answer format. If your parents suffer from diabetes, you can ensure they have the knowledge and understanding to deal with diabetes with confidence and success.

What is diabetes?
Diabetes is a condition in which there is increased sugar (glucose) in the bloodstream. This happens because the pancreas does not produce enough insulin or because the body tissues are resistant to the action of insulin.

Insulin is responsible for moving glucose from the blood into the body cells especially after meals. It acts like a key opening a door into the cell for the glucose to enter. So, when there is no insulin or when the body is resistant to its action, glucose cannot enter the cells and accumulates in the blood. Increased blood glucose, over time, leads to progressive damage to blood vessels and nerves.

What are the symptoms of diabetes and how are they caused?
Many people with diabetes may not have any symptoms.

Fatigue is often the first symptom. Since glucose is unable to enter the cells, the muscles tire easily because they do not have the basic fuel they need for power.

Meanwhile, the glucose that cannot get into the cells of the body builds up in the blood. The kidneys are able to reabsorb all the glucose in the blood until blood glucose level is more than 180 mg/dl. Once the glucose in the blood exceeds 180 mg/dl, it passes through the kidneys into the urine and carries water along with it. So, extra water is lost in the urine resulting in thirst and increased intake of water. So, fatigue, increased urination and increased thirst are all symptoms of glucose not being able to get into your cells.

Also, you may lose weight even though you are eating plenty of food because nutrients are unable to enter your cells.

How is diabetes diagnosed?
Normal blood glucose is less than 100 mg/dl after an 8-hour fast and less than 140 mg/dl after a two-hour glucose tolerance test.)

Diagnosis of diabetes is confirmed if: Prediabetes (impaired tolerance of glucose) indicating increased risk of developing diabetes in future is diagnosed if: What are the different types of diabetes?
What are the complications of diabetes?
If not controlled, the raised blood sugar level can progressively damage the delicate capillaries as well as the larger blood vessels and nerves in all tissues.

The most common complications of diabetes are: What are the principles of treatment of diabetes?
Diabetes usually cannot be cured or reversed.

The principles of treatment are: How should diabetes be monitored?
How should the complications of diabetes be monitored?
What is the treatment of diabetes? What is hypoglycemia?
Hypoglycemia means low glucose level in the blood (below 70 mg/dl) and is usually seen in diabetics treated with insulin or anti-diabetic tablets such as Glimepiride (Amaryl), Nateglinide (Starlix), Glipizide (Glucotrol), Repaglinide (Prandin), and Glyburide (Glynase). It is either caused by exercise, delay in meal or increased dose of anti-diabetic medications. Early signs include shaking, sweating, hunger, anxiety, weakness, dizziness, rapid heartbeat, lightheadedness, sleepiness, confusion and difficulty in speaking. The immediate solution is to take about 2-3 spoonfuls of sugar or 4-6 glucose biscuits. Repeat after 15 minutes if the blood sugar is still low. Inform your doctor who may reduce your anti-diabetic medication.

Hypoglycemia is more common in the elderly and more dangerous so they must take extra precautions to deal with it. What precautions about medications should be taken?
The elderly usually have more than one illness and have to take many medications several times a day. It is important to help them by labeling all medications clearly. If they are likely to miss or repeat doses, their medicines must be kept in individual boxes and labeled with the date and time when they are supposed to take them.

Elderly people with diabetes may be handicapped by insufficient knowledge of how to deal with their illness. The best way you can help your diabetic parent is to provide him or her with adequate information about diabetes. This will enable them to gain a better understanding of how to control diabetes and prevent its complications. It will also help them to be more responsible for their own health.

References:
1. Haslett Christopher et al, eds. Davidson’s Principles and Practice of Medicine. 19th ed. Oxford: Churchill Livingstone, 2002
2. Barnard Neal, Dr. Neal Barnard’s Program for Reversing Diabetes. New York: Rodale; 2007


Contributed by: Dr. Rohi Shetty