Carbohydrate disorders in the elderly
Diabetes type 2 becomes more common as we age. In the 1990s, it was estimated that this disease occurs in approximately 20% of men and 30% of women in the sixth and seventh decades of life . Currently, it is believed that the prevalence of diabetes in the population of people over 65 years of age is over 40%. Additionally, in the elderly, a high incidence of carbohydrate disturbances corresponding to the categories of impaired glucose tolerance or impaired fasting glycaemia has been demonstrated.
The pathogenesis of diabetes in the elderly
Aging has complex effects on carbohydrate metabolism. It is believed that in old age the most characteristic abnormality of carbohydrate metabolism is the gradual increase in the value of fasting insulin and after meals. Diabetes doctors in Coimbatore suggest that aging is a process with the development of tissue insulin resistance. Some studies indicate that the key pathogenetic factor responsible for the development of carbohydrate metabolism disorders is not aging itself, but the accompanying gradual increase in visceral adipose tissue, which induces insulin resistance . It has been shown that the most important factor determining insulin resistance is waist circumference (40% variability), not age (10-20% variability).
Different results were obtained in the Baltimore Longitudinal Study of Aging In which, despite taking into account the degree of obesity and the distribution of adipose tissue, advanced age was an independent factor deteriorating glucose tolerance. Other factors analyzed in this study were coexisting chronic diseases, medications, and immobilization.
The second factor whose dysfunction is responsible for the development of carbohydrate metabolism disorders in the elderly is the reduction of insulin production. In the Baltimore Longitudinal Study of Aging , after taking into account the effect of obesity and fat distribution, an age-proportional decrease in insulin levels was observed in response to oral glucose administration. Currently, it is also believed that with age the function of β cells is impaired, which is manifested by a decrease in insulin secretion in response to an increase in blood glucose levels.
General guidelines for the management of elderly diabetes
Diet treatment
In the elderly, there is no simple correlation between the current caloric intake and the degree of obesity, which is typical for younger patients. Often, elderly people suffer from obesity or only abdominal fat distribution as a result of improper diet, practiced from adolescence. There is also no clear evidence that weight loss in elderly diabetic obese patients results in a longer life expectancy. Therefore, the recommendations for patients over 70 only refer to maintaining the current body weight.
Physical activity
It has been proven that in the elderly, moderate physical activity significantly reduces the cardiovascular risk, even if it is not accompanied by a significant decrease in body weight.
Hypoglycemia in elderly diabetic patients
Hypoglycemia is the most common metabolic side effect in elderly and diabetics remains the basic factor limiting the intensification of diabetes therapy in this patient population. The most common risk factors for hypoglycemia are: advanced age, polytherapy, recent hospitalization, the use of sulfonylureas (especially older generations) and / or insulin, malnutrition, comorbid disease (chronic kidney, liver or cardiovascular disease), excessive exercise, eating alcohol, hormonal disorders (e.g. hypothyroidism), use of antihypertensive drugs (non-selective β-blockers), lack of physiological hormonal counter regulation and hypoglycemia unawareness.
The main risk factors for hypoglycemia associated with the use of sulfonylureas are high dose, advanced age and skipping a meal. One should also remember about the possible influence of drugs that enhance the effect of sulfonylureas, such as salicylates, sulfonamides, dicoumarol derivatives, MAO inhibitors, allopurinol. In the elderly, the occurrence of hypoglycemia during treatment with sulfonylureas requires prolonged 2-3 days of observation [10]. In elderly people using insulin, the most common causes, and at the same time risk factors for a hypoglycemic episode, are errors in insulin dosing (too high dose, incorrect time in relation to the meal, wrong type of insulin), insufficient glucose supply (skipping a meal, fasting, gastroparesis causing delayed glucose absorption), increase in insulin sensitivity (loss of weight, excessive physical activity) and alteration of pharmacokinetics (renal failure, injection of insulin in the wrong place).
Summary
The elderly population is characterized by the presence of metabolic disorders, which include: abdominal fat tissue, insulin resistance, impaired insulin secretion, dyslipidemia, hypertension, and carbohydrate disturbances. Multidirectional treatment of diabetes mellitus in the elderly, taking into account education, lifestyle changes, and appropriate selection of drugs, allows to reduce mortality, frequency and severity of complications of this disease, as well as improve efficiency and increase the independence of patients, which significantly affects the quality of life of patients and reduces costs social diseases.
Comments
Post a Comment