Diabetes in Elderly Patients – a concern

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Diabetes in elderly people above 65 years of age nearly contributes to 25 to 30 percent of the whole population. Diabetes is a very common but a serious chronic ailment. Some of the people take it lightly. Type 2 Diabetes being more prevalent in elderly people. The role of genetics plays a very important part in elderly population.

Factors contributing Diabetes in elderly:

  • Obesity
  • Sedentary lifestyle
  • Faulty eating habbits like sweets, chocolate etc
  • Lack of exercise
  • Smoking
  • Alcohol affecting liver and pancreatic metabolism
  • Autoimmune diseases

All these factors contribute or I can say play major role in Diabetes apart from genetics or hereditary family history.

The studies have shown that patients have several metabolic abnormalities, including altered glucose-induced insulin release, increased fasting hepatic glucose production and marked resistance to insulin-mediated glucose disposal.

diabetes and elderly

Image credits: Aging.com

Symptoms in elderly group:

Symptoms of type 2 diabetes may include:

  • Fatigue
  • Increased thirst or hunger
  • Losing weight without trying
  • Urinating often in night
  • Blurred vision.
  • Repeated Skin infections like candidiasis or slow healing from cuts and bruises.
  • Insomnia, disturbed sleeping pattern due to increased frequency of urination in night time.

Some people with type 2 diabetes may not realize they have it because symptoms often develop slowly and go undiagnosed. Sometimes older adults ignore these symptoms as “getting old,” but they can be indication of a serious problem.

Pathophysiology:

When the glucose levels in the blood increases, we say that a person is suffering from Diabetes. Our body gets it’s energy from food. When we eat food a lot of glucose is formed which gets converted to energy. Insulin converts glucose into energy. The production of insulin is controlled by pancreas. Hence the insulin production is less or the patient is insulin resistant, glucose levels in blood increases, leading to Diabetes.

Senior citizens and middle aged population are at high risk of developing Diabetes. Mostly they develop type 2 Diabetes. Nearly 15 to 20 percent of population are Prediabetics.

Now what do you mean by Prediabetics? It is a condition where in the sugar levels in blood are marginally high and is undiagnosed.

Management of Diabetes in elderly:

Firstly the diagnosis and management of a prediabetes is very important. Regular checkups and monitoring glucose levels is of utmost importance. Improvement in lifestyle and way of living is of great help to the individual.

Diet also equally contributes in management of Diabetes. Having healthy diet and following plate diet is of utmost importance. Grapefruit, bitter gourd and black jamun are some foods that help in reducing blood sugar levels.

Going for daily walks or exercise really helps to burn out extra glucose or fat in our body by utilizing energy. Being active is the key mantra to keep Diabetes at Bay. Yoga, pranayams, meditation help a lot to prevent depression.

Avoid drinking water in night after 9 pm helps bladder control and prevents increase frequency of urination in night. Thus this prevents disturbed sleeping pattern.

Taking your timely medicine metformin or insulin as prescribed by your diabetologist prevents further complications of Diabetes.

Regular eye check-up helps you to avoid complication like retinopathy. If any nerve pain or age related neuropathy then one must visit a neurologist for advice and monitor glucose levels. Charcot’s foot and gangrene can be avoided by keeping sugar levels under check. Also be cautious of any injury or a slip.

Stay Safe# Stay Healthy# Prevent Diabetes.

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Diabetes & Depression Link Diagnosis Treatment

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Hello friends, today we shall discuss about diabetes and it’s role in depression. What’s depression about?  Dealing with depression is not a social stigma. Both these diseases are global issues and around 19 million of the population of the world is suffering from these diseases. The prevalence rates of depression could be up to three to four times higher in patients with type 1 diabetes and twice as high in people with type 2 diabetes compared with the overall general  population worldwide.

Depression actually means when a person is disappointed due to some reason and is sad all the time with mood swings, doesn’t want to do anything,  a very laid back attitude, can binge chocolates and food in depression or not eat at all. The incidence of occurrence of depression is about three to four times higher in patients suffering from diabetes. About 12% of the Indian population is suffering from diabetes where in depression remains undiagnosed. Depression could be explained as a first episode, a recurrent or chronic episode. It could be mild, moderate or severe, with or without psychotic features.

Diabetes and depression link:

Diabetes and depression go hand in hand. People suffering from depression often land up borderline diabetes or prediabetes state.

  • Managing diabetes can be stressful, monitoring factors, which can lead to depression.
  • Faulty eating habits, sedentary lifestyle,  lack of exercise, obesity,  smoking,  managing diabetes can lead to depression.
  • On the other hand,  depression itself lead to lack of communication,  lack of interest in anything,  no exercise,  insomnia, irregular eating habits etc which can lead to diabetes.

Diabetes and depression are the most common causes amongst people and a serious medical condition.  Depression being the 4th cause, while diabetes the 8th cause of disability adjusted life years (DALYS) in developed countries.

Diabetes and depression

Image credit: thediabetescouncil.com

Physiology of Depression in Diabetes :

People suffering from diabetes reveal mood swings and emotional changes. Any alteration of blood sugar levels leads to alteration of mood swings, low feeling and irritability.

Diagnosis of Depression or depressive features in Diabetes:

Before starting my diabetes practice i have also did more than 2 plain posts (6 months each) in psychological medicine department in BMC hospital mumbai where i used to see an alternate day OPD of more than 80-100 patients under the guidance of AMO and HOD. i can still remember that my AMO was used to teach me from DSM 5 of psychological medicine book how to distinguish from depressive features or traits from Major Depressive Disorder (MDD).

Based on my experience if you want to diagnose that whether you have depressive features or not ? just ask yourself 5 questions !

  1. Is there a feeling of worthlessness, helplessness, hopelessness, loss of self esteem?
  2. Do you cry when your alone ?
  3. Do you feel sad or low with or without reason? ( repeated negative thoughts which affects your sleep and appetite)
  4. Have you lost interest in your daily activities? (e.g avoiding your relatives friends) 
  5. Do you feel that your life is not worth living or is better to die? (there’s nothing left in this world for you / suicidal ideation)

if your answer is YES to any 3 of the above questions you may be suffering from depressive features and you should consult a expert in psychological medicine or MD psychiatrist.

Management of Depression in Diabetes :

Both diabetes and depression have  the potential to cause a dangerous vicious cycle if not treated at the correct time. Constant monitoring is required to manage blood sugar, medication side effects, health care services and other related health conditions can lead to an increased risk of depression.

Treating diabetes type 1 or type 2 is of utmost importance so that diabetes complications can be well avoided. Also depression should be treated with appropriate anti depressant medication and regular counselling /psychotherapy under the guidance of expert in psychological medicine or MD psychiatrist. The patient should be made to realise the importance of improving lifestyle changes,  regular exercise and timely medication.  Eating healthy food is also of prior importance.  Plate diet method in diabetes is very helpful in controlling diabetes. Sleeping pattern should be maintained properly.

Impact of depression on diabetes:

Depression increases the risk and accelerates the risk of diabetes and it’s complications like retinopathy,  neuropathy,  macrovascular diseases, gangrene etc.  Many people think that both these diseases are isolated and do not have any link between them. But various studies have proven that there is a cause and effect cycle between the two diseases. Well ignoring your depression and not accepting it due to social stigma doesn’t help one much.

Let’s conclude this article, considering that how important are these 2 D’s in our lives and so well linked with each other.

 

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Diabetes and Sleep Disorders

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Type 2 diabetes mellitus (T2DM) is mostly associated with higher incidence of sleep disorders, which may be due to disease itself or due to secondary complications of diabetes. However, shorter sleep duration and erratic sleep behavior itself have been linked with higher incidence of obesity, metabolic syndrome and T2DM. Sleep disturbances are more common in people suffering from diabetes. Diabetic patients usually suffer from sleep disorders like insomnia, day sleepiness, disturbances in sleeping pattern, etc.

Multiple factors may contribute to insomnia in persons with diabetes:

  • pain associated with peripheral neuropathy
  • periodic limb movements
  • restless leg syndrome
  • rapid changes in blood glucose levels during night leading to hypoglycemic and hyperglycemic episodes, nocturia and depression.

Sleep Disorders and diabetes

Image Credit: Thediabetescouncil.com

Categories of Sleep:

The categories of sleep disturbances that contribute to obesity and T2DM include the following:

(1) alterations of sleep duration, chronic sleep restriction, and excessive sleep

(2) alterations in sleep architecture

(3) sleep fragmentation

(4) circadian rhythm disorders and disruption (i.e., shift work).

Epidemiological data have suggested higher risk of obesity and T2DM in individuals with shorter sleep duration (<4–5 h/night) as well as those of poor sleep quality.

Difficulty initiating sleep increased the risk of T2DM by 57%, while difficulty maintaining sleep increased its risk by 73%. Similarly, the risk of developing T2DM associated with insufficient (≤5 h/day) or excessive sleep duration (≥9 h/day) or performing shift work was comparable to that of being physically inactive.

Two studies revealed that the insulin response to an oral glucose challenge was higher when comparing the total sleep deprivation condition to the normal sleep condition. This suggested that an insulin resistant state was induced by acute sleep deprivation. Another study reported that a 1-week period of sleep restriction (only 4 h of sleep daily) in young, healthy subjects could lead to a prediabetic state.

Metabolism and Mechanism of sleep disorders and diabetes :

Possible causes of impaired glucose metabolism in sleep disordered breathing (SDB) might be intermittent hypoxia and sleep fragmentation associated with them. Sleep fragmentation increases sympathetic activity, which in turn increases blood glucose levels by decreasing insulin sensitivity.

Diabetes and Sleep Apnoea:

Obstructive sleep Apnoea (OSA) is a sleep-related breathing disorder characterized by collapse of the upper respiratory tract leading to cessation of airflow in the setting of continued respiratory effort. This results in hypoxia which inturn leads to frequent arousals causing sleep fragmentation and symptoms of excessive daytime sleepiness. The prevalence of OSA in the population with type 2 diabetes may be as high as 24%, and the prevalence of any SDB may be as high as 59%.

Common symptoms of OSA include:

  • Loud snoring
  • Frequent cessation of breathing during sleep
  • Choking and gasping episodes during sleep
  • Waking up sweating during sleep
  • Feeling unfreshed in the morning after apparently adequate night sleep
  • Morning headaches
  • Excessive daytime sleepiness and lethargy
  • Rapid weight gain and cognitive deficits

Evaluation of sleep disorders :

Assessment of sleep quality, sleep disorders, and sleep hygiene is of primary importance in persons with diabetes. As discussed earlier above,  etiology of sleep disruption in diabetes is often multifactorial. Hence, a detailed history, careful examination and some laboratory investigations will be required for successful evaluation and subsequent treatment of sleep disorders in this population. Maintaining a 2 week diary would help ascertain the sleeping pattern.

Management of sleep disorders:

Behavioral approaches are very important in the management of insomnia, which include adherence to good sleep hygiene, sleep restriction, cognitive behavioral therapy, and relaxation therapies. Yoga, meditation,  improving life style also helps in improving sleeping patterns. Eating excessive in night time result in increase glucose levels in blood which may lead to nocturia. Thus eating habits needs to be monitored on regular basis and exercise daily to maintain body weight. BMI needs to be monitored.

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Diabetes Reversal Program with Weight Loss

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Hello Readers, we all know what is diabetes and it’s consequences if untreated or not monitored properly. Let us discuss about the most common question asked by my patients. Can Diabetes be reversed by weight loss?. The answer is yes.  According to the recent study by American Diabetes Association, when the patient loses 10% of  the body weight in the first five years of diagnosis of diabetes, it is possible that Diabetes can be reversed. Here the body metabolism plays an important role during weight loss.

Diabetes remission is defined as partial when glycated haemoglobin test (HbA1c) is less than 6.5 without diabetes medication for a year; and complete when HbA1c is less than 5.7 without medications for a year. The haemoglobin A1c is an indicator of the average glucose over the past 3 months. A healthy score is below 5.6%

According to the normal physiology, when there is excess fat deposit over liver and pancreas, the insulin production is hampered which fails to control the glucose levels in the blood. Thus resulting in diabetes. When the person loses weight, the pancreas work more efficiently. There is improvement in the beta cell function which in turn results to sufficient production of insulin to control glucose levels in the blood.

Diabetes reversal

Image Credit: Wealthy.care

Usually, a 2 month trial is sufficient for one to judge the diabetes reversal. Also life style changes like avoiding sedentary life style,  exercise on regular basis and improved plate diet plan for diabetes can help achieve the goal. Later on once the goal is achieved, it is very important to maintain the body weight so that the beta cell in pancreas is not hampered.

Approximately around 66.8 million or nearly 7 crore people in India are suffering from diabetes ie. almost 1 in every 11 indian is diabetic. majority of public in india is unaware that they have either prediabetes or diabetes. People suffering with low risk of diabetes can be reversed by healthy diet and exercise. After a considerable weight loss, one can stop the medicine and monitor the glucose levels. This is how weight loss can reverse diabetes.

Diabetes is a progressive disorder , when a person 1st time get diagnosed as Diabetic his/her almost 50% of beta cell reserve is exhausted but at the same time 40-50% is still viable and producing insulin. if that person loses a sufficiant amount of abdominal fat by weight loss through diet and exercise. his remaining 40-50% beta cell reserve may be able to maintain blood sugar levels in normal range for atleast few months to few years depending on other contributing factors like genetic history, diet intake, intensity of exercise, age, duration of diabetes etc. 

this is a reversible phenomenon, if a person regains a weight then again insulin resitance will increase and blood sugar levels may start again to rise.

Prof. Roy Taylor conducted a trial study on 149 individuals called the Diabetes Remission Clinical Trial (DiRECT) which revealed promising results of reversal of diabetes with weight loss and diet plan. In this study participants reduced more than 15kg of weight loss to get the desired results either by diet and execise or some used bariatric surgeries for weight loss. This study proved beneficial to those people who had borderline diabetes and also those who were recently diagnosed. Daily regular workouts help in achieving the goal. Constant monitoring of weight and sugar levels is required as it is a long term disease plan. Saturated fatty acids in the liver and pancreas affect the beta cell production of insulin and also lead to insulin resistance.

Management:

Regular medication and exercise is required. Metformin tablet is used as a medication for treatment of diabetes which is a insulin sensitiser and also acts as a anorexic agent to some extent. Plate diet is also very effective in diabetes.

Having Fenugreek, black jamun, bitter gourd, grape fruit are some of the old school home remedies to control diabetes.

Insulin therapy in severe cases is necessary for effective results. there has been a various research papers submitted in various journals across world regarding 2 weeks of insulin therapy in Newly detected T2DM patient can get his off the medicines atlest for 1st few years.

Avoid, smoking, aerated drinks, carbohydrates that increases the glucose levels in the blood.

Ketogenic diet which is low carbohydrate diet restricts about 20 to 40gms of carbohydrates a day which also helps in reducing the glucose levels in blood but in indian foods it is very unlikely to achieve for longer duration.

 

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