If you have diabetes, you hear a lot about the goals set by the American Medical Association (AMA) and the American Diabetes Association (ADA) for things like blood sugar, blood pressure, and weight.
Many doctors will treat you according to the standards of care given to them by the AMA and ADA. That is modern medicine. But are those goals right for you?
As we get older, more of the people around us will have diabetes. In 1993, 41% of those diagnosed with it were over 65. According to the Centers for Disease Control and Prevention (CDC), half of older adults have prediabetes.
For this reason the ADA recommends screening people for diabetes age 45 and older at regular three-year intervals. It makes sense to do this because it is so easy to have diabetes without knowing it.
More people with diabetes means more people getting hypoglycemia, or low blood sugar. You can develop Type 1 diabetes at any age, and many of us with Type 2 need insulin sooner or later. The use of insulin and some other medicines that lower blood sugar, such as sulfonylureas, means there is a chance of having low blood sugar sometimes.
But the desire to get our blood glucose levels to the goals set by the ADA may be leading to serious consequences for older people with diabetes. This is because hypoglycemia can become more dangerous as we grow older.
One reason is “hypoglycemia unawareness.” Typical early warning signs of low blood sugar like sweating, trembling, and anxiety may diminish if we have had diabetes for many years. The more hypoglycemic episodes we have, the less responsive our bodies become, until we are not aware we are having a low blood sugar attack before the number sinks dangerously low.
What is worse, often these attacks happen at night. If we are asleep and do not rouse quickly enough, it is possible to slip into a coma without waking.
Another problem is confusion. Low blood sugar affects our brain fast. If we are already having cognitive issues because of age, it may be impossible to react properly to a hypoglycemic event. Checking blood sugar levels and getting a snack can be beyond the ability of a person who is foggy-brained from low blood sugar.
I will never forget the first time I had a low blood sugar episode. I wandered to the refrigerator to get some milk, and the jug slipped out of my hand, hitting the floor. My daughter heard the noise and came into the kitchen to help me. It was hard to feel so helpless.
Many years and many low blood sugar episodes later, I’ve learned to be quicker to ask for help. But it brought home to me the dangers we face from hypoglycemia.
The simple truth is that hypoglycemia is a risk in treating diabetes. The CDC says older people with diabetes are five times more likely to be admitted to the hospital because of low blood sugar episodes.
They say the risks of seizures, coma, and brain damage make it important to take hypoglycemia very seriously. This is why many doctors who treat older people with diabetes are using different A1C goals than those they set for their younger patients.
It seems that the risks from low blood sugar may outweigh the benefits of a hemoglobin A1C of roughly 7% or lower in frail older people — in this population, an A1C of 8% or less is thought to be a more realistic goal. My endocrinologist has backed me away from trying to keep the number close to 6%, because she fears that I have been having low blood sugar episodes at night without being aware of them.
Some geriatric specialists are raising their targets for blood sugar, blood pressure, and weight. Because most older people with diabetes have multiple medical problems, health-care providers need to tailor the care to the individual.
One issue is that with diabetes there is a higher risk of depression. Another is cognitive problems like forgetfulness that make it hard to stick with a complicated medication regimen. We can forget doses or take too much.
I once grabbed the vial of short-acting insulin instead of long-acting and had to sit up for hours drinking orange juice every 15 minutes and checking my blood sugar. It was scary.
Getting older with diabetes means a higher risk of falling because of vision problems or from nerve damage in our feet and legs. Low blood sugar can make us clumsy, and there are unexpected drug interactions and side effects that can cause dizziness or blackouts.
My older sister, who has Type 2 diabetes, fell off a step one day. She was unconscious for several days and lost some fingers from one hand because the doctors did not realize she had broken her shoulder. It was a freak accident, but age and diabetes increase our risk for such things.
An article in the ADA journal Clinical Diabetes says this: “Nationally published guidelines often do not apply to geriatric care, and practitioners’ individualized approaches to therapy are highly variable.”
What does all of this mean to those of us who are aging with diabetes? It means we do not have to accept the general goals set by “standards of care.” The best thing our doctors can do for us is to ask, “What are your goals for your care, and how can I help you?”
Do you want to have less pain? Doctors know that pain is an underreported and undertreated problem. This is why they ask about it at every visit. If you wish you could stop hurting, talk about it.
Have you ever thought about what you really want your goals to be? Do you want to live another 30 years or lose a lot of weight or just be able to walk? What would you change if you could? Can your doctors help you get there?
Would you like to make your own standard of care, set your own goals?
You can. It is your life.
What are chia seeds, and can they help you control your diabetes? Bookmark DiabetesSelfManagement.com and tune in tomorrow to learn more from nurse David Spero.