Managing diabetes as you age

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The National Diabetes Service Scheme (NDSS) recently conducted a national survey of people aged over 65 years and their carers and healthcare professionals. With more than 740,000 (63%) of people on the NDSS over the age of 60 years, the survey identified that many diabetes resources were not tailored to the information needs of older people.

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As a result, the NDSS has developed a series of booklets which give good general advice and tips about living with diabetes for older people.
Managing diabetes as you age has information to help people manage the effects of ageing and diabetes. It includes information such as how to treat a hypo, sick day management guidelines and Advance Care Planning. The booklet also covers issues specific to older people such as memory loss, managing falls and managing multiple medicines.
Healthy eating has information about healthy eating and food choices for older people living with diabetes. Much of the mainstream food and nutrition information is not targeted at people in this age range and the booklet covers topics including nutrition and daily food needs as you age, healthy weight ranges for older people, losing your appetite and how to gain weight if you are sick, frail or have lost weight. It has daily meal plans, delicious recipes and tips for shopping and cooking for one or two.
You and your health care team has information to help people with diabetes to understand and work with their healthcare team. It also covers programmes and plans that older people living with diabetes can access including GP Management Plan, Team Care Arrangements, Home Medicines Review and Aged Care Assessment Team/Services. It includes information on how to make the most of a visit to the doctor and what to do when sick including sick day management guidelines and who to call and when. It also has information about personal alarms which can be very useful for older people with diabetes who live alone.
The booklets were developed in consultation with older people, health professionals and a panel of experts in the subject of diabetes and ageing. The booklets are in large print and are very clear with tables and dot points to make the resource easier to read.
Below is a sample of the booklet contents:

• Getting older can mask some diabetes symptoms
  
  
  
  • It can sometimes be difficult to tell the difference between symptoms and signs that are caused by diabetes and those that are part of the ageing process. For example when you were younger, and your blood glucose levels were high, you may have felt thirsty. As you get older, if you have high blood glucose levels you may lose your sense of thirst. This may affect the way you manage your diabetes and may unknowingly cause you to become dehydrated.
  
  
  
  


• The blood glucose targets you had when you were younger may no longer be safe for you as you age
  
  
  
  • If you are frail, or if you take other medicines or have other health problems, you may be at greater risk of hypoglycaemia (‘hypo’) and falls. Once you turn 65, ask your doctor to review your blood glucose targets regularly.
  
  
  
  


• Growing older can add extra risk factors which can lead to hypo
  
  
  
  • These risk factors include having a poor appetite, being on four or more medications, or having kidney disease or other illnesses or conditions. You may find that your hypo warning signs change as you get older. When you were younger, early warning signs of a hypo may have included hunger, sweating, weakness, trembling, headache, dizziness, and tingling of the mouth and lips. As you get older, your warning signs may become less obvious. You may just feel tired or confused or you may feel nothing at all. If you think your warning signs have changed, please discuss this with your doctor or diabetes educator.
  
  
  
  


• The way our body uses medicines can change with age, and medicines can work differently if you have a poor appetite, miss a meal or become less active
  
  
  
  • There is help out there, in the form of aids and information. If you are concerned about the number of medicines you are taking and how they interact, you can ask your doctor to arrange a Home medicines Review for you. A specially qualified pharmacist will visit you at home, and go through the medicines you take and your daily routine. The Home Medicines Review will provide your GP with recommendations about how best to manage your treatment in line with your lifestyle routines and health conditions. From here, your GP will work with you on any necessary adjustments.
  
  
  
  


• Many older people worry about their ability to think clearly and remember
  
  
  
  • For most older people, thinking and memory stay relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. All people with diabetes over the age of 65 should have their memory checked by their doctor once a year.
  
  
  
  


• As we get older, we have a higher risk of falls that can cause serious injuries
  
  
  
  • Having diabetes further increases that risk because you may experience hypos or hyperglycaemia, or your diabetes may have affected your vision, balance or the feeling in your feet. You are also more likely to be on multiple medications, which can also increase your risk of falls. It is important to let your doctor know if you are worried about falling or if you have a fall, even if you don’t hurt yourself.
  
  
  
  

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“The booklets were developed in consultation with older people, health professionals and a panel of experts in the subject of diabetes and ageing.”

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Further reading
The Older People with Diabetes National Development Program is funded as part of the National Diabetes Services Scheme which is an initiative of the Australian Government administered by Diabetes Australia. Leadership for the Older People with Diabetes National Development Program is provided by Diabetes Tasmania.
The booklets Managing Diabetes As You Age, Healthy Eating and You and Your Health Care Team are available online at ndss.com.au or by calling the NDSS Infoline on 1300 136 588. For more information about the development of the booklets or about other resources relating to diabetes and older people, contact: Caroline Thomas, National Program Leader at cthomas@diabetestas.org.au