Care
Whether you’re newly diagnosed or an old hand, living with either type of diabetes brings special considerations when you’re over 70. Dietitian Helen Gibbs explains.
Ageing well with diabetes
O
lder people with diabetes need to eat a healthy diet, and other aspects of nutrition may need to be considered alongside their diabetes.
A NEW DIAGNOSIS
One of the least well-known risk factors for type 2 diabetes is increasing age. Our cells simply become more resistant to insulin as we get older. This is exacerbated if we become less active because of other health conditions. Many people who find themselves newly diagnosed with type 2 in their 70s or beyond feel upset about it. Often, they’re carrying only a small amount of excess weight and have led active lives until relatively recently. They may also be anxious about the idea of diabetes complications affecting their end of life. GO EASY ON WEIGHT LOSS
While an older person with type 2 diabetes who is very overweight may benefit from some weight loss, many older people should stay the same weight. Research has shown that carrying a small amount of excess weight over the age of 70 reduces the risk of poor health, and people who are overweight are less likely to end up with fractured hips. I usually say to overweight older clients that I want them to have some padding if they fall. My target weight for them is a BMI of about 27. AVOID LOW BLOOD SUGAR
When I review an older person for diabetes, whether their diagnosis is new or long-standing, I let them know I’m concerned about hypoglycaemia. Avoiding hypos becomes more important as you age. Older adults may be more susceptible to hypos, and hypos can lead to falls. Interestingly, a study published this year in the Journal of the American Medical Association found that adults with type 1 diabetes who were over 60 years old had significantly fewer hypos when they used a CGM.* For those with type 2 who are on sulphonylurea meds (such as glipizide and gliclazide), hypos can be particularly severe, and, for some of those people, it’s actually easier to manage blood glucose on one of the long-acting insulins rather than by tablets. The recommendation for older adults with type 2 is to set a slightly higher target for good diabetes control in partnership with your diabetes team. We generally say aim for an HbA1c of 59 rather than 53. * https://jamanetwork.com/journals/jama/article-abstract/2767159
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DIABETES WELLNESS | Summer 2020
Individualised advice on diet and lifestyle is important for an older adult living with diabetes.
DIABETES AND OTHER HEALTH ISSUES
Malnutrition and becoming underweight are greater health risks than diabetes for older people. If an older client with type 2 has unplanned weight loss, I usually seek a medication review, and we talk about managing diabetes medically while we encourage them to eat high-energy and high-fat foods to maintain or increase body weight. I also keep a watchful eye out for a very late onset type 1. I recently saw an 88 year old who was newly diagnosed with type 1, and this was a timely reminder. Another situation where type 2 can occur for the first time is during treatment for cancer. When looking at dietary changes, we need to ask if treatment is curative or palliative. Food is ultimately about quality of life, and I would rather people ate what they enjoyed if their time is short, rather than being stressed about making dietary change. ASK FOR HELP
If you’re an older person with diabetes, don’t be afraid to ask for help to individualise your diet changes for all your health conditions. While everyone should be given individualised advice on diet and lifestyle, this is even more important for the older adult living with diabetes. Ask your GP for a referral to a dietitian locally, or find a private practice dietitian via Dietitians NZ at dietitians.org.nz.
