Age-related diabetes mellitus. Normal glucose readings. Video: Diabetes mellitus in the elderly

21.06.2019

Non-insulin dependent diabetes mellitus is one of the most common diseases in old people.

According to research, the incidence of this type of diabetes:

age 50-59 years up to 8%;
age 60-69 years 8-12%;
age 70-79 years 14-20%;
age over 80 years 25%.

According to information from epidemiologists obtained as a result of studies in Moscow, the real incidence of type 2 diabetes is even higher. It exceeds the registered frequency by 2-4 times. The reason is too late diagnosis.

Specificity of the clinical picture of type 2 diabetes in the elderly

What diabetes mellitus in old age it is not diagnosed immediately, it is caused by the blurred clinical picture of the disease. At this age, complaints of pruritus, increased urination, and thirst, traditional for diabetes, are not so typical. The main place in the list of patients' complaints is taken by such complaints uncharacteristic of diabetes as drowsiness, weakness, headaches, memory lapses, forgetfulness, and visual impairments. This leads to difficulties in making a diagnosis and in almost half of the cases leads to the development of severe complications of a microvascular and macrovascular nature in people with unrecognized type 2 diabetes.

Complications of non-insulin dependent diabetes mellitus in old people

The main problem for these people it is considered:

combating noticeable symptoms of hypo- or hyperglycemia;
preventive measures to prevent coma;
creating conditions for caring for people with type 2 diabetes.

Conditions best correction people in old age (with a short life expectancy) are considered:

lack of manifestations of high or low blood sugar;
fasting sugar content - 9-10 mmol / l;
НВА1с 8.5-9.5 percent;

If you adhere to these criteria, it makes it possible to avoid complications in the form of a diabetic coma.

Treatment of type 2 diabetes in old age

The main component of treatment diabetes mellitus the elderly have a correct diet and a certain degree of physical activity, but this does not lead to the achievement of the desired quality of metabolic control. Therefore, for the treatment of people with diabetes, it is advisable to use oral hypoglycemic drugs, if necessary, insulin. When prescribing a tablet drug to an elderly diabetic, one should not forget about the presence of an undesirable toxic effect of the drug. This is due to the failure of some organ systems of the elderly patient.

Most older people suffer ischemic heart disease and its complications, impaired liver and kidney function. In 50-80% of patients in old age, hypertension is detected. The diuretics used cause blood thickening and an increase in the concentration of the drugs used.

The most dangerous for elderly diabetics are hypoglycemic conditions... These conditions arise either from an overdose of drugs, or as a result of a reduced rate of utilization and elimination of the drug from the body. Hypoglycemic conditions are dangerous in old age in that they can cause the development of a hypertensive crisis, acute myocardial infarction, developing against the background of spasm of the coronary vessels, loss of vision.

Choosing a drug for treatment

Ideal hypoglycemic drug for the treatment of the elderly should have the following properties:

minimal risk of a hypoglycemic state;
lack of toxic effects on the kidneys and liver;
ease of use (1-2 doses during the day);
high efficiency.

Gliclazide ("Diabeton") - one of the drugs with all the listed properties is produced by the French company Servier.

Diabetone helps to increase insulin secretion. This drug restores the physiological profile of insulin production in diabetics. The physiological profile is built from two phases:

1st phase - "fast" phase, characterized by high production of insulin, which occurs 15-20 minutes after the injection of the drug, this phase ensures the utilization of carbohydrates after eating;
2nd phase - "slow" phase, less pronounced, lasts for 3 hours or more, this phase controls glycemia between meals.

The severity of the 1st phase under the action of Diabeton depends on the initial glycemia: the more fasting glycemia, the more insulin secretion.

Unwanted effects

The risk of a hypoglycemic state in people taking Diabeton, even with an initially low glycemic level, is minimal. A Canadian multicenter study in 1993 proved that when taking Diabetone the incidence of hypoglycemia does not exceed 5% of episodes per year. With other drugs, the incidence is 15-20%. Even in cases of using an average dose of the drug, which is 80 mg twice a day, an acceptable compensation for metabolic disorders was achieved.

Follows with utmost caution to prescribe drug therapy to elderly patients with functional failure of the liver and kidneys, since against its background, the accumulation of the drug and an increase in its toxicity are possible. It is known that 60-70% of gliclazide is utilized by the kidneys, 10-20% - by the gastrointestinal tract. Studying the pharmacokinetics of the drug, pharmacists have established that Diabeton is excreted through special eight inactive metabolites. All these metabolites do not have a hypoglycemic effect. The main metabolite is a carboxylic acid derivative with a strong disaggregation effect. Due to this, even with functional kidney failure, Diabeton does not cause cumulation of the hypoglycemic effect, but contributes to the disaggregation effect.

The presence on the background of sufficient compensation of carbohydrate metabolism when taking Diabetone in senile people with type 2 diabetesdiabetic nephropathy does not act as an indication for discontinuation of the drug and the transition of the patient to insulin therapy.

Numerous multicenter studies have substantiated the efficacy and safety of using Diabeton in the treatment of type 2 diabetes among different age groups, all this makes it possible to classify this drug as a first-line drug for the treatment of elderly diabetics.

The incidence of diabetes is becoming large, and an increasing number of people, from the youngest to the older generation, are falling ill with it. According to WHO statistics, more than 100 million people worldwide have diabetes today. . Diabetes mellitus in old age is approximately 9% at the age of 60-65 years, and by 75 years - 23%.

The increase in sickness in old age is caused by a number of features of changes in carbohydrate metabolism:

Insulin resistance is most pronounced in people who are overweight. In people without obesity, the most common factor in the disease is a decrease in the production (secretion) of insulin.

Naturally, these indicators are approximate, since everything happens individually for everyone. The risk of diabetes mellitus in the elderly largely depends on the lifestyle, nutrition, and the number of "accumulated" chronic diseases. All these factors are interconnected.

According to research by scientists, people who were first diagnosed with diabetes mellitus already had the following diseases:

Neuropathy (a disease of the nervous system);
Ischemia of the heart;
(eye disease);
Changes in blood vessels, especially;
Chronic kidney disease;
Arterial hypertension;
Chronic diseases of the gastrointestinal tract.

More than half of the patients already had some percentage of these chronic diseases and suffered from microvascular complications. The occurrence of diabetes mellitus and the pathology of other organ systems increases the risk of complications and the course of the disease, the correction of treatment.

Dry skin, itching;
Constant thirst;
Frequent urination
Deterioration of vision;
Swelling of the legs, cramps.

The presence of all the listed symptoms is not necessary, the appearance of one or two is enough.

Symptoms in the elderly in development are expressed to a greater extent by dry skin and itching, weight loss against the background of normal nutrition, severe weakness.

With the development in the elderly, the main symptoms are intense thirst, weakness, a sharp deterioration in vision, and non-healing of wounds.

To diagnose diabetes, you need to take blood and urine tests for sugar. The percentage of type 2 diabetes in older people is higher than type 1. Often, there are no special symptoms, but when examining, for example, the fundus of the eye, diabetes is revealed. Therefore, after 45 years, it is recommended to take tests every 2 years to check the glucose level. The sooner it is, the less the risk of complications, the easier it is to treat. Cases when diabetes mellitus is diagnosed at a late stage are quite common.

Hypoglycemia is a particularly dangerous complication in the elderly.-low glucose levels. The manifestations of hypoglycemia in young people and in the elderly differ in symptomatology.

Features of hypoglycemia in the elderly

There are no clear symptoms. Disguise as other diseases, therefore it is often not diagnosed;
The pronounced symptoms of hypoglycemia in young people in the form of sweating and tachycardia, in the elderly are manifested by weakness and confusion;
Due to the weakened effect of the exit from the state of hypoglycemia (weakened function of the counter-regulatory systems), hypoglycemia has a long-term character.

The danger of hypoglycemia is expressed by a complication of the work of the heart and vascular system, which is very dangerous for elderly patients and is harder to tolerate by their body than at a young age. With frequent conditions of hypoglycemia, elderly patients often lose balance and orientation in space, this causes them to fall with fractures and dislocations.

In older people, the onset of this disease is possible while taking a variety of medications that interact with each other. And it is difficult for a doctor to take into account all possible side effects. For example, when beta-blockers are taken, hypoglycemia is blocked until the patient faints. And some sulfonamides increase tissue insulin sensitivity.

In these cases, it is recommended for the elderly to a minimum. A special therapeutic diet is prescribed, which should include natural fats and proteins (building material for cells). This is done so that, against the background of a low-carbohydrate diet, a person has the opportunity to drink less drugs. This means that the possibility of complications with hypoglycemia decreases.

Unfortunately, many elderly people are left to live out their days alone, which aggravates their state of mind and increases the state of depression, in which the patient loses interest in self-control of his health. Or he simply forgets to take medications on time.

For older people, goals are individual. Depends on how long the life span of a diabetic is:

The presence of cardiovascular pathologies;
The body's tendency to hypoglycemia;
The state of functioning of the kidneys and gastrointestinal tract;
The number and presence of severe complications;
The patient's capabilities for self-control.

Diabetes mellitus in older people with normal physical activity is easier and with fewer complications. This is because the body of an elderly person is most sensitive to physical activity, so that improvement in the condition will not take long. Taking into account the presence of other diseases, methods of physical rehabilitation are selected together with the doctor.

You need to go hiking for at least 30 minutes. per day, increasing daily time by 5-10 minutes. If you wish, you can always choose the best physical activity that brings healing and pleasure.

It is important to remember that the development of type 2 diabetes is most often due to an inappropriate lifestyle. The best recommendations for the prevention and treatment of the elderly would be as follows:

Complete rejection of all bad habits;
Exercise, swimming, daily walking;
Maintaining your inner state on an optimistic "note";
Constant use of a therapeutic diet;
, especially with obesity;
Constant, pressure control.

Prevention of diabetes in the elderly is, first of all, educational work of the causes of the development of the disease and the possibilities of solving them, properly organized treatment adequate to the age and general condition of the patient.

Ivan Viktorovich. Hello! I recently crossed the 60-year mark. My daughter has, I measured my sugar several times after dinner - it shows from 7.5 to 8.5 - 8.7. I read about the symptoms of diabetes, but I do not seem to have thirst and itching, my appetite is good. My daughter is afraid that I might have diabetes. Can sugar rise so much after 60 years? How are sugar norms ranked based on age?

You did the right thing in deciding to measure your blood sugar level, because 7.5 - 8.5 mmol / L - fairly high levels of sugar after meals (postprandial glycemia).

In general, it is not customary to rank blood sugar norms by age; they are approximately the same for people of all ages. If there are differences, they are insignificant. In infants, they are slightly lower than in older people.

However, the risk of developing type 2 diabetes increases with age. Diabetes is a condition that occurs when blood sugar rises because the body cannot use glucose correctly. If you are overweight and over 45 years old, there is a risk of developing type 2 diabetes.

Blood sugar rates

What are the blood sugar norms? They change throughout the day. Normal fasting blood sugar levels for adults of all ages should not exceed 5.5-5.7 mmol / liter.

Before meals, during the day, the blood sugar rate fluctuates around 3.3-5.5 mmol / l.

Postprandial blood sugar, measured two hours after a meal, should not exceed 7.7 mmol / L. These are normal numbers for people without diabetes, regardless of their age.

If you have diabetes, endocrinologists advise keeping your blood sugar level before meals from 4.5 to 7.2 mmol / L, and 1-2 hours after meals - up to 9 mmol / L.

There is also analysis for (HbA1c), which shows the average blood sugar level over the last 2-3 months. HbA1c is expressed as a percentage. The norm of glycated hemoglobin for a person without diabetes is from 4 to 5.9%. The target for diabetics is 6.5% and is recommended by the International Diabetes Federation. A diabetic can make it lower if he wants to closely monitor his glycemia.

It is becoming increasingly popular that diabetic patients should maintain their sugars. how can you closer to the norms of healthy people without diabetesbecause such control protects against the development of diabetic complications.

For example, Dr. R. Bernstein, in his book Diabetes Solution, writes that normal blood sugar values in diabetics should be in the region of 75-86 mg / dl. ( 4.16 - 4.72 mmol / l ). In his opinion, an excellent level of glycated hemoglobin should be from 4.2% to 4.6% , which corresponds to the above sugars.

This glycemic level requires a careful diet and more frequent blood sugar measurements to keep it from dropping to a low level (). Such harsh conditions are quite feasible for most patients. This is very helpful in following a low-carb diet according to the method.

If your blood sugar level after eating rises to 8.5 - 8.7 mmol / L, then this is a sign of diabetes. Considering that you are 60 years old, this is type 2 diabetes. You need to contact an endocrinologist to prescribe additional tests to clarify the diagnosis. In particular, you need to get tested for and pass a glucose tolerance test. If the glucose tolerance test shows a sugar over 11.1 mmol / L, then you will be diagnosed with diabetes mellitus.

Lazareva T.S., endocrinologist of the highest category

Diabetes mellitus is a very dangerous and insidious disease. The first symptoms of diabetes mellitus, people may confuse it with mild malaise, the action of an infectious disease. For many, diabetes mellitus can be secretive. As a preventive measure, it is necessary to check the blood sugar level every six months, this will help to identify the disease at an early stage, especially in people who are at risk. The glucose level can be measured at home, for example, using a special device called a glucometer. A blood test in the clinic is usually taken from a finger, but can be taken from a vein. At home, the meter can measure the level from a drop of blood.

After 5 seconds, the device will show an accurate result. If the glucometer test showed a deviation of the sugar level from the norm, it is necessary to take a blood test from a vein at the clinic, in the direction of your doctor. This way you can clarify whether you have diabetes or not.

To obtain reliable test results, it is necessary to measure blood glucose levels strictly on an empty stomach for several days. It is best to test blood from a vein and finger in a medical facility laboratory.

Some men and women make a mistake when, before the analysis, they drastically change their diet, start eating right, "go on a diet."

You can't do that!

This leads to the fact that the true state of affairs with the pancreas is hidden and it will be more difficult for the doctor to accurately diagnose. When taking a sugar test, consider your emotional state and other factors.

Fatigue, pregnancy, chronic illness, all of this can significantly affect glucose levels and deviations from the norm. It is not recommended for men and women who will be tested to work overnight, stay up late. Before the test, you should first get a good night's sleep.

Video: Diabetes. Three early signs

Remember!

In a healthy person, the blood sugar level is always measured on an empty stomach, with the exception of the delivery of clarifying tests, when blood can be drawn after a meal.

Men and women who are over 40 years old must be tested for sugar, as they are at risk.

In addition, you need to monitor the rate of blood sugar in women during pregnancy, as well as overweight people.

Table of blood sugar norms in women by age

Sugar norms for women and men are basically the same, but there are differences.

The result will depend on some parameters:

The analysis was given on a lean stomach or after eating
The sugar rate changes with age, after 60 years in women and men, the indicator may increase

If a person eats normally, leads an active lifestyle, does not abuse alcohol, is not a drug addict and the analysis shows elevated glucose levels, then the patient can be suspected of developing diabetes mellitus.

The unit of measurement for this blood parameter is millimole per 1 liter of blood (mmol / l). An alternative unit is milligram per deciliter of blood mg / 100 ml (mg / dL). For reference: 1 mmol / L corresponds to 18 mg / dL.

Normal glucose values \u200b\u200bdepend on the age of the patients.

Regardless of gender, both men and women should always take care of their health and monitor the sugar rate, passing prof. examinations, blood and urine tests.

Sugar rate in older women

Check your blood sugar!

This is especially true of the norm of blood sugar in women after 40 - 50 - 60 - 70 years.

Usually, in older women, glucose levels rise exactly two hours after a meal, and fasting glycemia remains near normal.

Reasons for an increase in blood sugar in women

This phenomenon has several reasons that act on the body synchronously.

Firstly, this is a decrease in the sensitivity of tissues to the hormone insulin, a decrease in its production by the pancreas. In addition, the secretion and action of incretins will weaken in these patients. Incretins are special hormones that are produced in the digestive tract in response to food intake. Also, incretins activate the production of insulin by the pancreas. With age, the susceptibility of beta cells decreases several times, this is one of the mechanisms of the formation of diabetes, no less important than insulin resistance. Due to their difficult financial condition, older people are forced to gnaw on cheap, high-calorie foods.

Such food contains: an extraordinary amount of rapidly digestible industrial fats and light carbohydrates; lack of complex carbohydrates, protein, fiber.

The second reason for an increase in blood sugar in old age is the presence of chronic concomitant diseases, treatment with potent drugs that adversely affect carbohydrate metabolism.

The most risky from this point of view are considered: psychotropic drugs, steroids, thiazide diuretics, non-selective beta-blockers. They are capable of causing the development of disturbances in the work of the heart, lungs, and musculoskeletal system.

Causes of hyperglycemia

The sugar level can be exceeded due to:

Because of junk food, when a person abuses sweets
alcohol abuse, smoking
due to nervous tension, stress
due to increased activity of the thyroid gland and other endocrine diseases
diseases of the kidneys, pancreas and liver.

Blood glucose can sometimes rise after taking steroids, diuretics, and some birth control pills. In women, blood sugar rises during pregnancy.

When the analysis showed elevated glucose levels (hyperglycemia), the patient is given 200 ml of water with sugar to drink the next time, and after 2 hours the test is again carried out. It happens that a person can rise to the level of blood glucose due to the fact that he ate a sweet apple.

Symptoms of hyperglycemia in men and women:

thirst
dry mouth
skin problems, severe itching
the patient is losing weight dramatically
blurred vision
worried about frequent painful urination
difficulty breathing, it becomes loud and uneven

For women over 60 years of age, type II diabetes mellitus is most inherent, which is defined as benign. It mainly goes in a trifling form and is not characterized by severe symptoms. Moreover, a significant part of middle-aged women do not even assume that they have a disease, which is why it is diagnosed late and most often by coincidence.

A distinctive property that can prompt the doctor that his middle-aged patient has diabetes mellitus is the presence of obesity in her, which indicates violations in the process of lipid metabolism.
Between the onset of the development of the disease and the formulation of a systematic diagnosis, there have been years during which an elderly madame is tormented by the occasional erasure of symptoms, but does not turn to a medical professional.

The classic symptoms that accompany diabetes in the elderly are:

pathology of sensitivity in the limbs;
the appearance of pustules on the skin;
decreased visual acuity;
the appearance of pain in the heart;
swelling of the face and neck area;
development of various fungal disorders, etc.

In the interests of older women, the development of trophic changes in the extremities, the appearance of signs of "diabetic foot" is also inherent. Trophic changes develop due to the effect of glucose on the blood walls.

For the elderly, the fairer sex is also characterized by the development of an unexpected and dangerously flowing diabetic coma. Usually, a sudden coma caused by high blood glucose levels is fatal in the elderly.

In more than half of the people whose analysis showed an increase in blood sugar norms, latent pancreatitis (inflammation of the pancreas) was revealed. The insidiousness of the disease is that the symptoms of pancreatitis may not show obvious signs, disguise themselves as other diseases and gradually destroy the tissues of the pancreas.

How to lower blood glucose levels

A balanced diet and a balanced diet can significantly reduce sugar levels. It is important to follow a diet for those who already have elevated blood glucose levels. Eliminate from your diet: animal fats, sweets, fast foods, juices, bananas, persimmons, figs, sugary soda, alcohol.

To normalize metabolism in the future, in order to maintain normal glucose levels, it is necessary to include in the menu: seafood, fish, beef, rabbit meat, vegetables, herbal teas, mineral water.

Video: Diabetes mellitus in the elderly

Why is diabetes mellitus so dangerous for older women?

The reason is that patients are unusually poorly tolerated cardiovascular complications, have every chance of dying from a stroke, heart attack, vascular clogging by a blood clot, acute heart failure.

There are also chances of being incapacitated and disabled when irreparable brain damage occurs.

A similar complication can appear at a young age, but a much older person tolerates it very difficult. When a woman's blood sugar rate rises quite often and unpredictably, this becomes the basis for falls and injuries.

Insulin is known as a pancreatic hormone. When the glucose concentration rises, the pancreas increases insulin secretion. In the case when there is not enough insulin, or not enough, glucose does not begin to transform into fat. If a large amount of glucose is accumulated in the blood, diabetes mellitus develops.

The brain at this moment can begin to actively use excess glucose, partially rid us of excess fat.

Over time, sugar can be deposited in the liver (fatty liver). It is just as dangerous when large amounts of sugar begin to interact with skin collagen, which is essential for the smoothness and elasticity of our skin.

Collagen is gradually disrupted, which leads to aging of the skin and the appearance of premature wrinkles.

Elevated glucose can lead to a deficiency of vitamin B. In general, vitamins and minerals are poorly absorbed by the body in diabetes mellitus.

High blood sugar speeds up the metabolism, people have problems with the kidneys, heart, lungs.

Diabetes mellitus weakens the immune system

Sugar gradually destroys the immune system, a person is exposed to more and more infections, viral diseases, the body loses its ability to effectively fight infection.

Thus, in both older women and men, an increase in glucose levels is quite common.

In order to prevent the development of diabetes mellitus, you have time to pay attention to changes in the indicators in the analysis and take appropriate measures. As a preventive measure against the disease, it is important to stick to a diet and maintain a healthy lifestyle.

Video: blood sugar rate in women, table by age

It is important to understand that usually the blood glucose levels in women and men have the same normal values. The level may vary according to age, the presence of a particular disease and the female characteristics of the body. Also, the time of taking the test and the conditions observed at the same time can affect the indicators of the norm of sugar in the blood..

The most common endocrine disease - continues to grow. According to the WHO, there are currently about 100 million patients with diabetes mellitus in the world. It is well known that diabetes mellitus in both men and women most often develops at the age of 50-60 years or more. The demographic situation is now such that the number of elderly and senile people in the world has increased significantly. This is the so-called aging process of the population. It is due to the contingent of older people that the number of patients with diabetes mellitus increases significantly, and therefore this pathology is now considered as a problem of age. Factors contributing to the development of diabetes mellitus in old age are a decrease in the synthesis and secretion of insulin, a decrease in energy processes and glucose utilization by peripheral tissues, atherosclerotic vascular damage, and a change in the permeability of cell membranes. It should also be borne in mind that in people over 60 years of age, there is quite often a discrepancy between the decrease in energy expenditure of the body and the consumption of food, as a result of which obesity develops. In this regard, in elderly and senile people, tolerance to carbohydrates decreases and under various adverse effects (diseases of the biliary tract and liver, pancreas, trauma, infections, neuropsychic stress and other types of stress), they develop diabetes mellitus. In the pathogenesis of diabetes mellitus, the key role belongs to insulin deficiency - absolute or relative. Absolute insufficiency is characterized by a decrease in the synthesis and secretion of insulin with a decrease in its content in the blood. In the genesis of relative insulin deficiency, the main importance is the enhanced binding of insulin by plasma proteins with its transition to an inactive form, the influence of hormonal and non-hormonal insulin antagonists, excessive destruction of insulin in the hepatic parenchyma, and a violation of the reaction of a number of tissues, primarily fatty and muscle, to insulin. In the genesis of senile diabetes, as a rule, it is these extra-pancreatic factors that dominate and the developing insulin deficiency is of a relative nature.
Age differences in the clinical course of diabetes mellitus are very significant, which led to the allocation of 2 types of it - adolescent and adult. Juvenile diabetes is a relatively rare pathology, the adult type occurs 14-16 times more often. In patients with juvenile diabetes mellitus, the disease usually manifests itself early (before the age of 15-20 years), and with an adult - after 40 years. In most patients with juvenile diabetes, the pathology is hereditary, while in adult diabetes, the presence of diabetes mellitus in the family can be established only in 20-40% of patients. Juvenile diabetes is characterized by an acute onset: no more than a few weeks pass between the onset of the first symptoms of the disease and the establishment of the diagnosis. Young patients complain of weight loss, thirst, polydipsia, polyuria, polyphagia (i.e., complaints due to uncomplicated diabetes). Before the onset of the disease, patients have a normal or reduced body weight. The course of the disease is labile, difficult to control, there is a tendency to develop ketosis and coma. The insulin content in plasma is reduced (absolute insulin deficiency), vascular and dystrophic complications develop 5-10 years after the onset of the disease and progress rapidly. These patients are usually insensitive to oral hypoglycemic drugs, and insulin administration is necessary to compensate for their hyperglycemia and glycosuria.
In elderly and senile patients (adult type of diabetes mellitus), the course of the disease is relatively stable, benign - usually mild to moderate severity. Overweight is observed in 60-80% of patients at the onset of the disease. The onset of the disease is gradual, clinical symptoms are scarce, and in this regard, between the onset of the disease and the diagnosis, it takes from several months to several years. In these patients, the insulin content in the blood can be not only normal, but even elevated (relative insulin deficiency). Compensation of diabetes mellitus in them is achieved quite easily - in patients with concomitant obesity, one diet is enough; ? patients respond well to treatment with oral hypoglycemic agents.
A special place in the clinic of diabetes mellitus in elderly and senile patients is occupied by its vascular and trophic complications. If in patients with juvenile tylosis the development of specific (microangiopathy) and nonspecific (microangiopathy - acceleration of the development of atherosclerosis) complications of diabetes mellitus is due to the pathology itself and the disorders of carbohydrate, lipid and protein metabolism arising from it, then in elderly and senile patients diabetes mellitus develops already against the background of existing atherosclerotic vascular lesions in various areas: coronary, cerebral, peripheral. In this regard, the clinical picture of these patients is dominated by complaints associated with complicated diabetes. This is a deterioration in vision, pain in the heart, pain and paresthesia of the legs, itching, swelling of the face, pustular and fungal skin diseases, urinary tract infection, etc.
Coronary atherosclerosis in patients with diabetes mellitus, compared with people without this pathology, occurs twice as often in men and 5 times more often in women. Much more often patients with diabetes develop myocardial infarction, which in turn complicates the course of diabetes. Atherosclerotic lesion of the vessels of the lower extremities is manifested by their chilliness, pain in the legs like intermittent claudication, paresthesias; the pulse in the posterior tibial and dorsal arteries of the foot is weakened or undetectable. In elderly patients with diabetes mellitus, gangrene of the lower extremities is observed 80 times more often in women and 50 times more often in men compared with healthy ones. Vascular lesions of the kidneys ("diabetic nephropathy") are diverse. This is atherosclerosis of the renal arteries with the development of renovascular hypertension, arteriolosclerosis, glomerulosclerosis. With decompensation of the disease, the vascular lesion of the kidneys progresses rapidly, leading to the development of renal failure in elderly and senile patients.
Urinary tract infections are very common (in almost 1/3 of patients) - usually acute or chronic pyelonephritis. Ophthalmic complications of diabetes mellitus include diabetic retinopathy, as well as “senile” cataract, which develops in diabetic patients much faster than in healthy elderly and senile people. Damage to peripheral nerves - diabetic neuropathy - is observed in elderly patients, more often in women with a mild but prolonged course of diabetes mellitus. Clinically, it is manifested by pain in the extremities (mainly the legs are affected), aggravated at night, paresthesias (burning, tingling), violation of vibration, tactile and pain sensitivity.
A serious complication of diabetes mellitus is a ketoacidotic coma; it occurs much more often in the juvenile type of the disease against the background of a slight change in the treatment regimen, with the slightest adverse effects. The development of ketoacidosis and coma in elderly and senile patients is promoted by infectious diseases, exacerbation of chronic cholecystitis, pancreatitis, pyelonephritis, purulent infections (carbuncles, phlegmon, gangrene), acute cardiovascular disorders (myocardial infarction, stroke), severe mental or physical trauma surgical interventions, the use of a number of drugs (diuretics, in particular hypothiazide, glucocorticoids, thyroidin, etc.).

Diagnostics diabetes mellitus in elderly and old patients is often difficult. Due to age-related changes in the kidneys, there is often a discrepancy between hyperglycemia and glycosuria (the absence of sugar in the urine with its increased content in the blood). Since the complaints of elderly and old patients are scarce and are usually associated with complications of diabetes, it is desirable to study blood sugar in all patients over 60 years of age with arterial hypertension, ischemic heart disease, atherosclerotic lesions of cerebral and peripheral vessels, chronic pyelonephritis, pustular and fungal skin diseases. On the other hand, it should be borne in mind that overdiagnosis of diabetes mellitus occurs in old and senile age. So, in people over 60 years of age, tolerance to carbohydrates decreases, and therefore, when conducting a glucose tolerance test, the blood sugar level normal for their age is interpreted as a sign of latent diabetes mellitus. As a rule, in elderly and senile patients, concomitant pathology is revealed, and therefore they take drugs that also affect carbohydrate metabolism. This leads to false positive or false negative results when examining people over 60 years of age. So, glucocorticoids, hypothiazide, estrogens, nicotinic acid increase blood sugar levels, while antidepressants, antihistamines, beta-blockers and acetylsalicylic acid, on the contrary, reduce it.
In elderly and senile patients, the diagnosis of hyperglycemic coma can be difficult: for example, with the progression of ketoacidosis, the appearance of nausea, vomiting, and abdominal pain can simulate a picture of an acute abdomen and lead to an erroneous diagnosis. Shortness of breath due to acidosis can be regarded as a manifestation of heart failure or exacerbation of chronic obstructive pulmonary disease. In turn, when making a diagnosis of diabetic coma, one must not lose sight of the fact that it could develop against the background of a cerebrovascular or cardiovascular catastrophe, uremia.

Most important in treatment diabetes mellitus in the elderly and old people has a diet. Since most of these patients have concomitant obesity, weight loss in itself is an effective measure for them, often leading to the normalization of blood sugar levels. As an independent type of treatment, the diet is used for mild diabetes mellitus. It is prescribed based on the "ideal" body weight (it is determined according to special tables) and the amount of work performed. It is known that in a calm state, energy expenditure per day is 25 kcal per 1 kg of body weight, with mental work - about 30 kcal, with light physical - 35 - 40, moderate physical - 40-45, heavy physical work - 50 - 60 kcal / kg.
Calorie intake is defined as the product of "ideal" body weight and energy consumption per 1 kg of body weight. The daily calorie intake of food is provided by 50% due to carbohydrates, 20% - proteins and 30% - fats. Elderly people should give preference to milk and vegetable food. With concomitant obesity, the daily calorie intake is reduced to 1500-1700 kcal, mainly due to carbohydrates. Patients with diabetes mellitus are not recommended fatty meats, fish, cheeses, cream, cream, animal fats, spicy snacks and seasonings, wheat bread, pasta, sweet varieties of apples, grapes, bananas, melons, pears, raisins, honey, sugar, pastry products. Recommended are lean meat and fish, eggs, vegetables and fruits (except for sweets), milk and dairy products, vegetable fats, black or special diabetic bread, oatmeal and buckwheat porridge, sugar substitutes - xylitol, sorbitol. Given the choleretic effect of the latter, their use is especially indicated in patients with concomitant cholecystitis, cholecystoangiocholitis. Treatment of patients begins with a low-calorie diet, which is gradually expanded with the normalization of blood sugar levels and the weakening of the clinical symptoms of the disease. If the diet is ineffective, drug treatment is additionally prescribed.
Most elderly and senile patients are sensitive to oral hypoglycemic drugs - sulfonamide (butamide, cyclamide, chlorpropamide, chlorocyclamide, bucurban, maninil, etc.) and biguanides (adebit, phenformin, silubin, glucophage, etc.). The main hypoglycemic effect of sulfa drugs is due to the stimulation of insulin secretion by beta cells of the islet apparatus of the pancreas. It is indicated for diabetes mellitus in adults (over the age of 40). Biguanides, unlike sulfonamides, act on extra-pancreatic factors - they potentiate the action of insulin by increasing the permeability of muscle tissue cell membranes for glucose and by increasing its utilization. The main indication for the appointment of biguanides is moderate diabetes, especially if it is combined with obesity. Biguanides are also prescribed for sulfa drug resistance. Oral hypoglycemic drugs are contraindicated in severe diabetes mellitus, ketoacidosis, liver and kidney disease, blood, during infectious diseases. Oral hypoglycemic drugs are effective in combination with insulin.
Insulin and its drugs in the treatment of elderly and senile patients have limited use, since among this age contingent, a severe course of the disease is rarely observed. Insulin is prescribed to such patients with resistance or low sensitivity to oral hypoglycemic drugs, during periods of aggravation of the course of diabetes mellitus (against the background of infectious diseases, myocardial infarction, stroke, gangrene of the lower extremities, uremia, with the development of ketoacidosis, during anesthesia, during surgical interventions and etc.).
In elderly and senile patients with drug therapy for diabetes mellitus, the sugar level is usually maintained at the upper limit of the norm or slightly above it. This is due to the fact that with an excessive decrease in sugar levels, an adrenaline reaction is realized, which is expressed in an increase in blood pressure, tachycardia, which, against the background of vascular atherosclerosis, can lead to various thromboembolic complications, including myocardial infarction, stroke.
In the treatment of elderly and senile patients, special attention is paid to combating the complications of diabetes mellitus. In this regard, drugs are prescribed that normalize carbohydrate metabolism - vitamins of group B, C, nicotinic acid; fat metabolism - miscleron, cetamifen, iodine preparations, lipocaine, lipoic acid, methionine; protein metabolism - retabolil, protein blood substitutes; mineral metabolism - potassium orotate, panangin, etc. They also use drugs that regulate vascular tone, vascular permeability, blood coagulation: heparin, syncumar, pelentan, hexonium, tetamon; papaverine, dibazol, no-shpu, ATP, angiotrophin, depot-padutin, depot-kallikrein; prodectin, dicinone; trypsin, chemotrypsin, lidase, ronidase, cocarboxylase. Oxygen therapy and physiotherapy exercises are shown.
Epidemiological studies have made it possible to identify a contingent of people with a high risk of diabetes. These are people with obesity, patients with atherosclerosis and arterial hypertension, elderly and senile people. Since atherosclerosis, arterial hypertension and obesity are especially often observed in people over 60 years old, it is quite obvious that their risk of diabetes is especially high.

Prophylaxis diabetes mellitus should include, first of all, a broad sanitary and educational work among elderly and senile people: they need to be familiarized with the causes, clinical picture, treatment of diabetes mellitus, focusing on the danger of excessive consumption of foods rich in carbohydrates, fats, on the need to control body weight , promote physical activity that doubles carbohydrates, taking into account age and individual capabilities.
Prevention of diabetes mellitus is also a rational therapy for elderly and senile patients, careful monitoring of the use of antihyperglycemic drugs.
Correctly organized treatment of patients with diabetes mellitus is the prevention of the development and progression of diabetic microangiopathy, atherosclerosis and other complications of this pathology.