Features of the course of diabetes mellitus in old age. Age-related decrease in tissue sensitivity to insulin. Diabetes in the elderly: symptoms

01.05.2019

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 don't 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 because 7.5 - 8.5 mmol / L - fairly high post-meal sugar levels (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. They are slightly lower in infants 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.

Nowadays, it is becoming more and more popular that people with diabetes should maintain their sugars. how can you closer to the norms of healthy people without diabetes because 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. Adherence to a low-carb diet according to the method helps a lot in this.

If your blood sugar level after eating rises to 8.5 - 8.7 mmol / L, then this is a sign of diabetes mellitus. 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 of more than 11.1 mmol / L, then you will be diagnosed with diabetes mellitus.

Lazareva T.S., endocrinologist of the highest category

With the passage of age, there is a decrease in sugar tolerance in almost all people. Starting from the age of 50, each subsequent decade, the fasting glucose concentration will increase by 0.055 mmol / L. The sugar level 2 hours after a meal will increase by 0.5 mmol / L.

People in old age are much more likely to develop type 2 diabetes than others.

It is important to note that these figures are just averages. In each case, the sugar concentration will vary in its own way. It directly depends on the way of life that the pensioner leads, and in particular, his nutrition and physical activity. Moreover, the glycemia on an empty stomach will not be significantly changed.

Reasons for the development of tolerance

Medicine explains this phenomenon by the fact that there are several factors at once that negatively affect the body:

decreased secretion and action of hormones in old age;
a decrease in the secretion of insulin by the pancreas;
age-related changes in tissue sensitivity to the hormone insulin.

Decreased tissue sensitivity to insulin is called insulin resistance. It can develop in a large number of older people, especially those who are overweight. In the absence of adequate treatment, there is a high likelihood of developing type 2 diabetes mellitus.

Diabetes mellitus in the elderly is the result of an overgrowth of insulin resistance. At the moment, doctors cannot give a definitive answer as to whether the tissue insulin resistance is a natural process caused by aging, or whether this phenomenon is the result of an unhealthy lifestyle.

For certain socio-economic reasons, retirees are forced to eat inadequate quality high-calorie food containing an extremely high level of unhealthy industrial fats and carbohydrates. As a rule, such foods lack protein, fiber and carbohydrates, which are absorbed for a long time.

It should be noted that the elderly have concomitant ailments and the use of drugs aimed at combating them. These medicines quite often can have a negative effect on the metabolism, namely carbohydrate. The most dangerous from the point of view of diabetes mellitus are the following:

steroids;
thiazide diuretics;
psychotropic drugs;
beta blockers.

Concomitant ailments can cause limited physical activity. These include various pathological processes in the lungs, heart and musculoskeletal system. As a result of these processes, muscle mass decreases, which becomes a prerequisite for exacerbating insulin resistance.

If you switch to a healthy lifestyle as early as possible, then the likelihood of developing type II diabetes in old age is significantly reduced.

Low insulin secretion

If the elderly do not have excess weight, then the main prerequisite for diabetes mellitus in the elderly of the second type is a defect in the production of insulin. It happens a little differently against the background of obesity - insulin will be secreted normally.

As soon as a person eats food with a high carbohydrate content, the glucose level immediately rises. The release of insulin from the pancreas is the body's response to overuse. This process takes place in two stages:

at the first stage, there is an intense secretion of insulin, lasting up to 10 minutes;
during the second stage, the flow of the hormone into the bloodstream is smoother, but prolonged - from 1 to 2 hours.

The first phase is necessary to extinguish the high concentration of blood sugar, which is observed immediately after a meal. In this case, it can help.

Recent medical research has shown that in older people with normal body weight, the first stage of insulin secretion is reduced. This is due to the high blood sugar content 2 hours after a meal.

In addition, in pensioners with normal weight indicators, a reduced activity of a special gene was noted, which ensures the sensitivity of the beta cells of the pancreas to glucose stimulation.

Its defect may be due to a decrease in insulin production in response to the influx of sugar into the bloodstream.

How is the treatment carried out?

Getting rid of diabetes mellitus in old age is a rather difficult task due to several factors:

concomitant ailments;
social factors (helplessness, poverty);
difficult learning;
senile dementia (sometimes).

This category of patients often has insufficient adherence to therapy. They can even arbitrarily stop taking medications and start treatment with folk methods, which do not always have a positive effect on their health.

If a diabetic in old age has anorexia or a serious depression, then in such cases, there is a violation of the adequate assimilation of drugs.

For each patient, it is necessary to establish the goal of therapy in a strictly individual manner. In many ways, the treatment regimen will be based on:

the tendency to develop severe hypoglycemia;
estimated life span;
the presence of problems with the heart and blood vessels;
the likelihood of developing complications of the course of diabetes;
the state of mental functions and the ability to follow the prescriptions of the attending doctor.

If the life expectancy is more than 5 years, then the goal of therapy in old age is to achieve the glycated hemoglobin HbA1C less than 7 percent. Assuming a life expectancy of less than 5 years, this figure should be less than 8 percent.

The concentration of glucose in the blood of an elderly diabetic should be reduced gradually and smoothly.

The use of tactics of aggressive and intensive control of blood glucose levels will only have negative consequences. The frequency of severe hypoglycemic conditions and deaths in type 2 diabetes mellitus will only increase.

For this reason, it is necessary to bring blood glucose into the normal range of values thoughtfully and over several months.

In managing diabetes and its symptoms, older patients should monitor:

glucose indicators;
blood cholesterol level (especially low-density);
blood pressure.

The specified indicators must be within the established norm. This will make it possible to exclude the development of complications. When deviating from the norm, the doctor will prescribe a set of appropriate measures:

therapeutic diet;
the use of statins;
drugs for hypertension.

insulin therapy;
treatment of diabetes mellitus without the use of medication (exercise and diet);
the use of pills for the disease.

All are aimed at adjusting the various mechanisms of the disease. We are talking about the increased sensitivity of tissues to the influence of the hormone insulin and the stimulation of its production (especially in the early phase), restoration of the effect of special hormones incretins on the pancreas.

Modern medicine has gained the ability to effectively fight diabetes thanks to the invention of the latest drugs from the incretin group. They should be understood as inhibitors of dipeptidyl peptidase-4 (gliptins) and mimetics and analogs of GLP-1.

It will become effective enough. If there is severe renal failure, then such a diet will be contraindicated. In other situations, a balanced diet will help improve health and maintain blood sugar levels within the normal range. Fluctuations in glucose concentration will be excluded, and the development of hypoglycemic conditions is minimized.

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 loss, 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 elderly people 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, which develops against the background of spasm of the coronary vessels, and 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 a meal;
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 influence 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, against the background of sufficient compensation of carbohydrate metabolism when taking Diabetone in senile people with type 2 diabetes diabetic nephropathy does not act as an indication for drug withdrawal and the patient's transition 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 agent for the treatment of elderly diabetics.

The incidence of diabetes is on a large scale, and an increasing number of people, from the youngest to the older generation, become 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 pathology of other organ systems increases the risk of complications and the course of the disease, and 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 required, 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 diabetes. 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 carry out treatment. 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 the young 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 the 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 the time daily by 5-10 minutes. If you wish, you can always choose the best physical activity that brings health and pleasure.

It is important to remember that the development of type 2 diabetes occurs most often due to an inappropriate lifestyle. The best recommendations for the prevention and treatment of older people are 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.

Diabetes mellitus in the elderly, symptoms and treatment

Diabetes mellitus is a lack of insulin in the human body; this disease belongs to the group of endocrine diseases. Diabetes produces large amounts of glucose in the blood, which negatively affects vitality.

Today in medicine there is an acute issue that affects the scale of the incidence of diabetes mellitus. These problems are acute in all countries of the world; people of different ages, from the smallest to the elderly, are susceptible to this disease.

It is more widespread among people of the older age generation, more often after 60 years.

A significant increase in patients suffering from diabetes mellitus is directly related to the characteristics of physiological changes during aging of the human body, there is a violation of the metabolism of carbohydrates.

The risk of developing diabetes in old age

In the age group over 50 years old, almost irreversible changes occur, which are accompanied by a decrease in glucose tolerance.

This means that gradually there is an increase in the presence of sugar in the blood on an empty stomach, after a meal, the process of concentration of glucose in the human blood takes place. Also, do not forget about the heredity of this disease.

All changes in the human body take place individually, each in a different way. Someone's processes are faster, someone is much slower.

The development of diabetes in older people is much higher than in the younger generation

The changes are influenced by the lifestyle that the pensioner leads, what is eaten, physical activity.

And in old age, the secretion and action of hormones such as incretins significantly decrease and weaken, the sensitivity of body tissues to insulin decreases. All this leads to not very good results, health begins to deteriorate.

Contributing factors in the development of diabetes mellitus

Lack of physical activity of a person;
Decrease in muscle mass;
Poor quality;
Incorrect carbohydrate metabolism.

When blood sugar levels rise, the body experiences a severe energy deficit, and this is a problem in the development of diabetes everywhere.

Types of diabetes

There is a division of diabetes mellitus into two groups. If there is a lack of insulin in the body, it is considered type 1 diabetes.

And when there is a violation of excessive insulin exposure, this is type 2 diabetes mellitus. Let's consider all types of the disease in more detail.

Type 1 diabetes

Diabetes mellitus type 1, it is also called juvenile diabetes, the disease manifests itself at different ages.

Video: Type 1 Diabetes Mellitus

A feature of this type of disease is insulin deficiency, which has a lifelong nature, accompanied by the destruction of beta cells.

The first type of disease has differences, autoimmune and idiopathic.

Type 2 diabetes

Type 2 diabetes mellitus is a defect in insulin secretion, the background for this is insulin resistance. It is associated with metabolic disorders.

At the same time, an increase in insulin is observed in the blood, which affects the metabolism.

Video: Signs of type 2 diabetes

Having considered the main types of the disease, it should be borne in mind that several more forms of diabetes mellitus are additionally identified, these include:

Defects in insulin genetics;
Diabetes due to the use of medications;
Diabetes transformed after infection has entered the body.

Decreased insulin secretion with age

Dangerous insulin resistance, if significant, is manifested even with a normal amount of insulin produced in the pancreas.

When a person eats foods high in carbohydrates, an increase in the amount of glucose in the blood occurs, which leads to the production of insulin by the pancreas.

This process takes place in two phases:

Intensive production of insulin by the pancreas, this process lasts about 10-15 minutes;
Smooth filling of the blood with insulin, this moment takes place for one to two hours after eating.

All sorts of medical studies have shown that a person has a significant decrease with increasing age.

If an elderly person has a normal body weight, a decrease in glucosinase activity is noticed.

This gene contributes to the sensitivity of beta cells in the pancreas, while stimulating the effect of glucose. Due to this nuance, there is a decrease in insulin secretion in old age.

Type 2 diabetes symptoms

That segment of the population that suffers from type 2 diabetes mellitus feels a lack of insulin in the blood, which forces people to become insulin dependent throughout their lives.

As a result of a lack of insulin, an increased blood glucose level is observed, which adversely affects the state of the circulatory system and other internal organs.

The symptoms of type 2 diabetes are:

Constant thirst, the person wants to drink all the time;
Increased urination, the patient constantly visits the toilet, exceeding the number of times from usual;
Unjustified loss of body weight;
Increased;
Constant weakness;
Unreasonable nervousness and;
Gag reflex and nausea.

If a person has these symptoms, you should immediately contact a specialist for help.

When a person delays referring to a doctor, there is a risk of getting a number of complications that can manifest themselves in diseases of the renal system, disorders in neurological manifestations, there is a special risk, it may even arise.

Type 2 diabetes mellitus is a rather dangerous disease that can lead to death.

Diagnosing diabetes in the elderly

When you go to the hospital, the first thing the doctor will prescribe is to donate blood from a finger for analysis, where the sugar level is determined. All people over 40 are advised to be tested for sugar at least once every two to three years.

Blood test for hemoglobin;
Analysis of urine for the presence of protein;
When a person has complaints of fatigue;
Significant visual impairment;
Lower limb problems.

Sometimes the diagnosis of a disease is made difficult by the absence of symptoms. Detection of the disease in elderly people is especially problematic.

This is associated with age-related fatigue, memory problems, dizziness, many of them lead to the conclusion that senile dementia is occurring, and do not go to the doctor in time.

When a person does not treat diabetes, the disease progresses and the consequences are unpredictable.

Type 2 diabetes treatment

Type 2 diabetes mellitus is difficult to treat, but still treatable.

Unfortunately, patients over the age of 45 have a large number of concomitant diseases that do not allow them to be treated in full.

There are several ways to conduct treatment:

Therapy without drugs. This course of treatment includes finding a person on a permanent basis, accompanied by physical activity. When dieting, restriction of food containing animal fats and carbohydrates is carried out. It is categorically impossible to use sugar-containing products, sugar substitutes will help with this. The diet should be constant in time, you can not skip food intake. Attention is also paid to the physical condition, for the maintenance of which it is necessary to do it uncomplicated, and will do;
Medication methods. There are many drugs available to lower blood sugar. The main groups of medicines used are: biguanides derived from thiazolidinone, acarbose, inhibitors, incritins and others. All medicines are used only as directed by the attending physician;
Insulin therapy. This is a set of necessary measures, which implies balancing the disorders of carbohydrate metabolism, which occurs as a result of the introduction of insulin into the patient's body.

A disease such as diabetes mellitus often leads to irreversible processes in the body, thereby significantly reducing the life span.

Conclusion

From all of the above, it should be understood that the earlier you go to the hospital with the slightest symptomatology, the more likely it is to start treatment on time.

The main responsibility for the state of health is borne by people for themselves. Take care of your health and your loved ones.