Managing diabetes and hypertension at an older age (greater than 60 years) may need adequate discipline and support from family or loved ones in terms of medication, diet, exercise, sleep, and rest. This is because older adults are at a higher risk of developing complications from the disease accompanied by other conditions related to aging such as depression, urinary incontinence, polypharmacy (use of different drugs for different conditions) and sarcopenia (progressive loss of muscle mass). A proper diet is especially important to provide adequate nutrients and energy required.
In older women still experiencing post-menopausal hormonal changes, symptoms such as irritability and trouble sleeping may cause fluctuations in blood sugar levels.
As your body changes, it is easier to confuse signs of menopause with symptoms of high or low blood sugars like dizziness, sweating, irritability, and trouble concentrating. Checking our blood sugars frequently at this age is therefore key.
In older men, levels of testosterone, the hormone that helps control sex drive, muscle mass and male sexual characteristics is usually lower compared to their younger counterparts. Low testosterone can cause insulin resistance, leading to poor blood glucose control. Medication, exercise and diet remain the mainstay for improved glucose control even in older adults. Testosterone therapy may be done to improve your blood sugar levels.
Medication
Glycemic goals and treatment options for the elderly should be individualized according to patient’s functional status, comorbidities (other chronic conditions), complications, and risk of hypoglycemia. Patients need to work closely with their doctors to set glycemic goals and understand their treatment options.
Nutritional requirements
Elderly persons may have difficulty getting adequate nutrition because of age and pre-existing conditions which may impair chewing, swallowing, and digestion. Their nutrient status may also be affected by decreased production of digestive enzymes, biological aging, or changes in the cells of the bowel surface and drug-nutrient interactions.
Energy requirements diminish with age due to decreased physical activity coupled with a decreased rate of metabolism. However, general healthy eating patterns apply equally to the young and old. Requirements of micronutrients may vary slightly in the elderly compared to the young. For instance, iron requirements are lower in older women since menstruation has ended. In men, iron requirements may remain the same as that of younger men. To reduce the risk of age-related bone loss and fracture, Vitamin D requirement is higher in the elderly compared to the young ones. .
Older persons need less energy
To achieve a lower energy intake, but maintain a high nutrient intake, it is important to focus on intake of nutrient dense foods. This can be done by having moderate amounts of vegetables, fruits, whole grains, legumes, nuts, seeds and lean protein, prepared with little or no saturated/trans fats, added sugars and sodium.
Consume more of plant-based carbohydrates, proteins, and fats. They contain more fiber that helps in digestion, reduces blood glucose spikes, and increases satiety. You may need gradually increase fiber intake especially if you have had gastrointestinal surgery.
Include dairy products in your daily meals, 2-3 servings in a day. They are a good source of calcium. Other calcium sources are soybeans and soy products, broccoli, kales, oranges and almonds
Moderate your total fat intake, such that you consume more of polyunsaturated and monounsaturated fats (healthy fats) and less of saturated and trans fats.
Reduce salt intake to less than 5 grams (equivalent to approximately 1 teaspoon) per day; use iodized salt
Choose foods with low GI and moderate GI and go for those that are locally available
Take enough water – up to 8 glasses in a day
Minimize intake of alcoholic drinks to 1 drink a day for women and two drinks a day for men. This is because of the increased risk of sleep disorders, delayed hypoglycemia, negative interactions with medication, and dehydration associated with excessive alcohol intake
Supplementation may be considered in instances where nutrition requirements are unable to be met through diet alone. This should be under the direction of a doctor or registered nutritionist.
Physical activity
Physically active elderly people have a higher level of cardio-respiratory and muscular fitness, better bone health, and healthier body mass and composition than those who are not. They also have lower rates of all-cause coronary heart disease, high blood pressure, stroke, type 2 diabetes, and some cancers.
Aim for at least 150 minutes of moderate aerobic activity every day for five days a week or at least 75 minutes of vigorous-intensity activity throughout the week. Start small and build momentum and intensity gradually. Perform aerobic activity in bouts of at least 10 minutes duration. Incorporate muscle-strengthening activities involving major muscle groups on two or more days a week
Moderate intensity Physical activity at this age may include brisk walking, riding a bike, taking stairs, gardening, and muscle-strengthening activities like lifting weights, squats, and sit-ups.
Sleep
Lack of sleep, insomnia, disrupted sleep, sleeping for less than 6 hours has been shown to increase the risk of developing hypertension, and cardiovascular disease. Lack of sleep has also been associated with elevated blood sugar levels and increased insulin resistance. Additionally, Sleep disturbances and deprivation also increases the levels of circulating hunger hormone, ghrelin and decreased levels of circulating satiety hormones, leptin, leading to overfeeding. This tendency to overfeed is coupled with the fact that those who sleep less are more likely to consume energy-rich foods, get higher proportions of calories from fats or refined carbohydrates, consume lower proportions of vegetables and fruits, and have more irregular meal patterns than those sleeping more. Ultimately increasing the risk of being obese and developing the metabolic syndrome (increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels). Try to get quality sleep of 7 to 8 hours every day.
Having a good social support system is of great importance as far as managing diabetes in the elderly is concerned. For this reason, family members should play an active role in ensuring the elderly meet their milestones of sleep, physical activity, medication and diet for improved Diabetes management.
