As age increases, body organs and various functions will decline. Diabetes is an age-related disease. Therefore, the prevalence of diabetes in the elderly is high. So what are the special characteristics of diabetes in the elderly? Today we take this opportunity to talk about several misunderstandings about diabetes in the elderly.
Misunderstanding 1: If blood sugar is normal during routine physical examination, everything will be fine
1. At least 30% missed diagnosis rate: Routine physical examination screening for diabetes misses at least 30%-50% of cases.
From the perspective of preventive medicine, early detection and treatment of diseases have the greatest benefits and the lowest economic costs, and the same is true for diabetes. Nowadays, everyone has a higher health awareness and conducts regular physical examinations. However, for the screening of diabetes in the elderly, a simple physical examination may miss some patients with diabetes or prediabetes.
The onset of diabetes in elderly patients is insidious and the symptoms are not obvious, so it is easy to miss diagnosis. Many elderly people have normal fasting blood sugar, but only have impaired glucose tolerance (IGT). Routine physical examinations screen fasting blood sugar. People think that if their blood sugar values are normal in their reports, they definitely do not have diabetes. This is a wrong view.
Data show that 30%-50% of newly diagnosed elderly patients with diabetes have normal fasting blood sugar and only elevated blood sugar after meals. Elderly patients with diabetes often have no clinical symptoms, and some patients only have some non-specific symptoms, which are mistaken for normal aging. These elderly people are often first diagnosed by non-diabetes specialists because of diabetic complications. If they are first diagnosed by ophthalmology because of vision loss, they are first diagnosed by cardiology because of hypertension and coronary heart disease, they are first diagnosed by nephrology because of kidney disease, and they are first diagnosed by gangrene of the lower limbs. At this time, abnormal blood sugar has developed to a relatively serious level.
2. Who needs further blood sugar screening: China’s expert consensus on type 2 diabetes prevention says this.
In August 2013, the "Expert Consensus on Prevention of Type 2 Diabetes in Chinese Adults (Draft for Comment)" issued by the Endocrinology Branch of the Chinese Medical Association mentioned that type 2 diabetes develops from prediabetes, and prediabetes can be considered a As a mark or watershed, people with high risk factors for diabetes should undergo fasting plasma glucose (FPG) or any point plasma glucose (RPG) screening. It is recommended that patients with FPG≥5.6mmol/L or RPG≥7.8mmol/L should further undergo an oral glucose tolerance test (OGTT). This consensus also mentioned that for the elderly, because FPG <5.6mmol/L or RPG <7.8mmol/L cannot completely rule out abnormal glucose tolerance (IGT) and postprandial blood glucose elevation, the elderly and other high-risk individuals (Confirmed coronary heart disease or multiple risk factors) It is also recommended to perform OGTT to determine the blood glucose metabolism.
Myth 2: Elderly diabetic patients should control their blood sugar as low as possible
Diabetic patients should try their best to control blood sugar to the target, but hypoglycemia corresponding to high blood sugar also needs to be paid attention to, especially among elderly people with diabetes. Elderly patients with diabetes have an increased risk of hypoglycemia and poor tolerance to hypoglycemia. They are more likely to suffer from unconscious hypoglycemia, nocturnal hypoglycemia and severe hypoglycemia, leading to serious adverse consequences. Because the sugar control target for elderly patients with diabetes is not as low as possible, individualized plans need to be formulated based on individual conditions.
1. Which patients should relax their sugar control goals: For patients with cognitive dysfunction (the 2017 version of China’s Type 2 Diabetes Prevention and Treatment Guidelines recommends that elderly diabetic patients over 65 years old be screened for depression and cognitive function once a year) Patients who have autonomic neuropathy, take β-blockers, or have a history of repeated hypoglycemia episodes especially need to be alert to the occurrence of severe hypoglycemia. These patients should appropriately relax their blood sugar control goals and try to use lowering medications with a low risk of hypoglycemia. Glucose drugs and closely monitor blood sugar changes.
2. Individualized hypoglycemic plan: hypoglycemic treatment for elderly patients with diabetes should be effective treatment under the premise of safety. Health education, reasonable diet, and safe and effective exercise should run through the entire process of elderly diabetes treatment, and different hypoglycemic targets should be given according to the patient's health status. See Table 1 for details. Table 1 Treatment recommendations for elderly patients with diabetes in different health conditions
Misunderstanding 3: Elderly patients with diabetes should also “eat less and exercise more”
Without detailed instructions, simply saying "eat less and exercise more" may not be conducive to disease control, but may be counterproductive.
1. Unscientific dieting aggravates the condition: In addition to abnormal blood sugar metabolism, elderly patients with diabetes often also have high blood pressure, hyperlipidemia, etc. For overweight and obese patients, it is necessary to control their diet, but if Simply going on a diet is not advisable. First of all, "eat less" does not mean "don't eat". Some patients simply interpret this sentence as not eating staple food. Some patients with high blood lipids do not eat meat or use boiled vegetables entirely. These practices are not advisable.
No matter what kind of metabolic situation, you need to eat scientifically. While controlling the total energy intake, you need to make the food balanced and complete in variety to avoid new health problems caused by improper diet. In addition, the elderly are prone to sarcopenia syndrome (sarcopenia). The reason is that with age, tendon hardness decreases, muscle bundles shorten, and muscle function decreases. Therefore, the dietary principles of the elderly are different from those of young people. , it is recommended for the elderly to increase their protein intake. Research recommends that the protein intake of the elderly in my country should be maintained at 1.0 to 1.5 grams of protein per kilogram of body weight per day, and an appropriate amount of high-quality protein rich in branched-chain amino acids such as leucine should be added. Protein, beef, shrimp and other foods are rich in leucine, so you can choose them appropriately. Elderly patients with diabetes often have sarcopenia, so they also need to pay attention to this issue.
For some diabetic patients who are losing weight, it is necessary to find the specific cause of weight loss, eliminate the original disease, and at the same time achieve the weight target through scientific diet.
2. Exercise safety is very important: Exercise helps stabilize blood sugar, but exercise prescriptions for elderly patients with diabetes also vary from person to person. More emphasis is placed on exercise safety. Appropriate exercise is enough, not that more exercise is better. Avoid exercising on an empty stomach, and strengthen blood sugar monitoring before and after exercise to prevent the occurrence of hypoglycemia.
The balance ability of the elderly decreases, and falls may occur. Therefore, the choice of exercise venues and forms of exercise is very important. For the exercise of elderly patients with diabetes, we cannot only emphasize the exercise itself, but also tell the patients how to exercise and what precautions to take. Patients with complications should choose different exercises according to the characteristics of their diseases to maximize their strengths and avoid weaknesses to achieve the purpose of safe fitness.
The elderly should pay more attention to their own health due to declining body functions and organ function. Elderly people with diabetes should monitor their blood sugar and learn more about diabetes.
