The elderly face several health problems, prominent among which are diabetes and bone and joint ailments. “Ten per cent of those currently above 65 years are diabetic and the next generation will turn diabetic at least a decade earlier,” says Dr. Rajendran's Diabetes Centre chief diabetologist, V. Rajendran.
Diabetes treatment for the elderly is difficult because many have other geriatric diseases, the drugs for which could interfere with diabetes control.
Many routine diabetes drugs are also unsuitable for the aged because unwanted side-effects become more pronounced with age, says Dr. Rajendran.
“Very strict control of blood sugar is also not possible since patients could turn hypoglycaemic (low blood sugar) and recovery is slower in the elderly. So, treatment must consider the patients’ basic capabilities for self-care such as bathing, feeding and cognitive impairment, as well as their financial and social support system.”
While race and heredity are non-monitorable, diabetes triggers diet exercise and emotional support play an important role, says chief dietician at K.G. Hospital, Priya Narasimhan. She says, “We see many elderly diabetics who also suffer from depression and hence do not eat right.”
She suggests caretakers give elders appetizers like soups before meals, as well as meals with colourful vegetables and fruits which could encourage eating well. “Keeping them company during meals will also help,” she adds.
The current generation of elderly diabetics include many who lead active lives, observes Dr. Rajendran. “This is so because, unlike the present generation, they have not lived sedentary lives with long work hours, fast food, day-to-day stressors and work pressures,” he says.
As the complications of diabetes are proportional to the duration of the disease, young diabetics must watch out.
Diabetics must have a high-fibre diet since it slows food absorption and delays hunger pangs says Narasimhan. “Consume plenty of fruits and vegetables, and include ginger, garlic and small onions in everyday cooking to maintain a good HDL level. Increase omega-3 fatty acids through walnuts and badams and change cooking oil on a monthly basis. Eight to ten glasses of water a day, along with daily exercise and meditation, are a must,” she says.
Complications from diabetes commonly affect eyes (diabetic retinopathy) and kidneys (diabetic nephropathy).
“It is mandatory to undergo a thorough eye check-up, including a retinal examination, the very day you are diagnosed diabetic. Follow-up examinations should be conducted every six months,” says Arvind Eye Hospital chief medical officer, V. Narendran. If diet and exercise are not monitored carefully, retinopathy will progress faster. If retinopathy is caught early enough, it can be treated through laser. “If diagnosed when vision is severely impaired and haemorrhages occur, treatment can only salvage vision partially,” he says.
“The first symptoms of diabetic nephropathy are protein leakage in the urine and if caught at this stage, you can control and even reverse the disease with drugs,” says Sri Ramakrishna Hospital nephrologist, N. Chezhiyan. He advises annual blood urea and serum creatinine tests along with abstinence from alcohol and cigarettes.
Advanced diabetic nephropathy requires either a kidney transplant or dialysis for life. “For the elderly, donor kidneys are especially hard to come by.
Moreover, dialysis costs upwards of Rs. 15,000 each month, which many can’t afford. So it is wise to to keep the disease under control from the beginning.”
