We've all heard that diabetes is on the rise in the US, but few people realize the degree to which older adults are disproportionately affected.
Frightening statistic: Nearly one out of every three Americans over age 65 has diabetes, the highest rate among all age groups. Another one out of three older adults has a precursor to diabetes known as "prediabetes" defined as a fasting blood sugar (glucose) level of 100 milligrams per deciliter (mg/dL) to 125 mg/dL.
Many people downplay the seriousness of diabetes. That's a mistake. Because elevated glucose can damage blood vessels, nerves, the kidneys and eyes, people with diabetes are much more likely to die from heart disease and/or kidney disease than people without diabetes-and they are at increased risk for infections, including gum disease, as well as blindness and amputation. (Nerve damage and poor circulation can allow dangerous infections to go undetected.)
And diabetes can be sneaky-increased thirst, urination and/or hunger are the most common symptoms, but many people have no symptoms and are unaware that they are sick.
Despite these sobering facts, doctors rarely have time to give their patients all the information they need to cope with the complexities of diabetes. Fortunately, diabetes educators, health-care professionals, such as registered nurses, registered dietitians and medical social workers-can give patients practical advice on the best ways to control their condition.*
*To find a diabetes educator near you, consult the American Association of Diabetes Educators, 800-8326874, www.diabeteseducator.org.
Good news: Most health insurers, including Medicare, cover the cost of diabetes patients visits with a diabetes educator.
What you've probably never been told about diabetes.
Savvy Eating Habits
Most doctors advise people with diabetes or prediabetes to cut back on refined carbohydrates, such as cakes and cookies, and eat more fruits, vegetables and whole grains. This maximizes nutrition and promotes a healthy body weight (being overweight greatly increases diabetes risk). Other steps to take…
- Drink one extra glass of water each day. The extra fluid will help prevent dehydration, which can raise glucose levels.
Never skip meals—especially breakfast Don't assume that bypassing a meal and fasting for more than five to six hours will help lower glucose levels. It actually triggers the liver to release glucose into the bloodstream.
Better strategy: Eat three small meals daily and have snacks in between. Start with breakfast, such as a cup of low-fat yogurt and wholewheat toast with peanut butter or a small bowl of whole-grain cereal and a handful of nuts.
Good snack options: A small apple or three graham crackers. Each of these snacks contains about 15 g of carbohydrates.
- Practice the "plate method." Divide a nine-inch plate in half. Fill half with vegetables, then split the other half into quarters-one for protein, such as salmon, lean meat, beans or tofu...and the other for starches, such as one-third cup of pasta or one-half cup of peas or corn. Then have a small piece of fruit. This is an easy way to practice portion control and get the nutrients you need.
- Ask yourself if you are satisfied after you take each bite. If the answer is "yes," stop eating. This simple strategy helped one of my clients lose 50 pounds.
- Be wary of "sugar-free" foods. These products, including sugar-free cookies and diabetic candy, often are high in carbohydrates, which are the body's primary source of glucose. You may be better off eating the regular product, which is more satisfying. Compare the carbohydrate contents on product labels.
Get Creative With Exercise
If you have diabetes or prediabetes, you've probably been told to get more exercise. Walking is especially helpful. For those with diabetes, walking for at least two hours a week has been shown to reduce the risk for death by 30% over an eight-year period. For those with prediabetes, walking for 30 minutes five days a week reduces by about 60% the risk that your condition will progress to diabetes. But if you’d like some other options, consider…
- "Armchair workouts." These exercises, which are performed while seated and are intended for people with physical limitations to standing, increase stamina, muscle tone, flexibility and coordination. For videos or DVDs, go to www.armchairfitness.com or call 800-453-6280.
Cost: $39.95 per video or DVD.
- Strength training. This type of exercise builds muscle, which burns more calories than fat even when you are not exercising.*** Use hand weights, exercise machines or the weight of your own body-for example, leg squats or bicep curls with no weights. Aim for two to three sessions of strength training weekly, on alternate days.
- Stretching—even while watching TV or talking on the phone. By building a stretching routine into your daily activities, you won't need to set aside a separate time to do it. If your body is flexible, it's easier to perform other kinds of physical activity. Stretching also promotes better circulation. Before stretching, do a brief warm-up, such as walking for five minutes and doing several "arm windmills." Aim to do stretching exercises at least three times weekly including before your other workouts.
Control Your Blood Glucose
If you are diagnosed with diabetes, blood glucose control is the immediate goal. Self-monitoring can be performed using newer devices that test blood glucose levels.
**Consult your doctor before starting a new exercise program
***If you have high blood pressure, be sure to check with your doctor before starting a strength-training program this type of exercise can raise blood pressure
Good choices: One Touch Ultra from LifeScan... Bayer's Contour...or Freestyle from Abbott Laboratories.
The hemoglobin A1C test, which is ordered by your doctor and typically is done two to four times a year, determines how well glucose levels have been controlled over the previous two to three months.
If you have prediabetes: Don't settle for a fasting glucose test, which measures blood glucose after you have fasted overnight. It misses two-thirds of all cases of diabetes. The oral glucose tolerance test (OGTT), which involves testing glucose immediately before drinking a premixed glass of glucose and repeating the test two hours later, is more reliable. If you can't get an OGTT, ask for an AIC test and fasting glucose test.
If you have diabetes or prediabetes, you should have your blood pressure and cholesterol checked at every doctor visit and schedule regular eye exams and dental appointments. In addition, don't overlook…
- Proper kidney testing. Doctors most commonly recommend annual microalbumin and creatinine urine tests to check for kidney disease. You also may want to ask for a glomerular filtration rate test, which measures kidney function.
- Meticulous foot care. High glucose levels can reduce sensation in your feet, making it hard to know when you have a cut, blister or injury. In addition to seeing a podiatrist at least once a year and inspecting your own feet daily, be wary of everyday activities that can be dangerous for people with diabetes.
Stepping into hot bath water, for example, can cause a blister or skin damage that can become infected. To protect yourself, check the water temperature on your wrist or elbow before you step in. The temperature should be warm to the touch—not hot.
Stay Up To Date On Medications
Once diabetes medication has been prescribed, people with diabetes should review their drug regimen with their doctors at every visit. Insulin is the most commonly used diabetes drug, but you may want to also ask your doctor about these relatively new medications…
- DPP-4 inhibitors. These drugs include sitagliptin (Januvia), which lowers glucose levels by increasing the amount of insulin secreted by the pancreas. DPP-4 inhibitors are used alone or with another type of diabetes medication.
- Symlin. Administered with an injectable pen, pramlintide (Symlin) helps control blood glucose and reduces appetite, which may help with weight loss. It is used in addition to insulin.
If you have prediabetes or diabetes: Always consult a pharmacist or doctor before taking any over-the-counter products. Cold medicines with a high sugar content may raise your blood glucose, for example, and wart removal products may cause skin ulcers. Pay close attention drug label warnings.
Take This Prediabetes Quiz
If you are age 65 or older, you are at increased risk for prediabetes regardless of the characteristics described below. For this reason, you should ask your doctor about receiving a fasting glucose test.
If you are under age 65, answer the following questions and speak to your doctor about receiving a fasting glucose test if you score a total of 5 or higher
Family History of Diabetes, Points
Heart Rate (beats per minute), Points
Less than 60………………...0
Greater than 100………………...4
High Blood Pressure, Points
Body Mass Index (BMI)**
Less than 25………………...0
30 or greater………………...3
*To determine your heart rate, place the tips of the first two fingers lightly over one of the blood vessels in your neck or the pulse spot inside your wrist just below the base of your thumb. Count your pulse for 10 seconds and multiply that number by 6.
**To determine your BMI, consult the National Heart, Lung and Blood Institute Website, www.nhlbisupport.com.bmi.