Diabetes is a disease that, if blood sugar levels are not properly controlled, can increase the risk of vascular diseases such as stroke and myocardial infarction at an early age, such as in their 40s or 50s. Preventing these complications is the goal of diabetes treatment.
Many people may think of diabetes as a disease characterized by elevated blood sugar levels. While a weakened ability to lower blood sugar is indeed a symptom of diabetes, it is only one aspect of the phenomenon. Simply put, diabetes is a disease that accelerates vascular aging. While there are many reasons why blood sugar levels can be difficult to lower, high blood sugar and high insulin levels can expose blood vessels to conditions that accelerate arteriosclerosis (vascular aging).
Diabetes in the Elderly: Beware of Lowering Blood Sugar Too Low
With aging, blood vessels gradually age. Consequently, many elderly people already have arteriosclerosis. When arteriosclerosis has already developed, overly strict blood sugar control is of little use. On the contrary, studies have shown that lowering blood sugar too low can accelerate the progression of cognitive impairment and increase the risk of falls, fractures, aspiration, and choking. In recent years, it has become widely accepted that blood sugar levels should not be lowered too low, and that a slightly higher level is actually better, especially for elderly people requiring care. As people age, their basal metabolic rate gradually declines. Therefore, we need to pay special attention to certain aspects of our diet and lifestyle to prevent complications of diabetes.
How to Prevent Diabetes
- Consume Whole Grains in Moderation
Because whole grains are rich in dietary fiber, which slows the digestion and absorption of carbohydrates, they are beneficial for people with diabetes. However, for elderly people with diabetes, whole grains should be consumed in moderation and should not be consumed at every meal. Elderly people have reduced gastrointestinal digestion and absorption capacity. Excessive intake of whole grains can burden the gastrointestinal tract and impair the absorption of minerals like calcium and iron, increasing the risk of conditions like osteoporosis and iron-deficiency anemia.
● A combination of coarse and fine grains is recommended: coarse grains should make up one-third of your staple food.
● Coarse grains can be finely ground or made into soft rice or thick porridge for easier digestion and absorption.
● People with poor gastrointestinal function or gastroparesis should avoid whole grains.
- High-quality protein is essential.
Some elderly people with diabetes have high blood lipids and deliberately become vegetarians. However, a complete vegetarian diet to lower blood lipids is not advisable. Elderly individuals need more protein; a deficiency can easily lead to sarcopenia, which can lead to more serious consequences.
● Elderly diabetics should consume one egg, 2-3 taels of lean meat (skinless fish, shrimp, poultry, or livestock), and appropriate amounts of soy products daily.
● Ensure 300 ml of milk or equivalent dairy products daily.
- Relax blood sugar control accordingly. Hypoglycemia is more dangerous than hyperglycemia, and elderly individuals have a poorer ability to detect it. Therefore, elderly diabetics should be cautious of hypoglycemia and avoid overly strict blood sugar control.
● For those in good health, A1C should be less than 7.5% (for those in poor health, A1C should be less than 8.5% to reduce the risk of acute complications). ● Fasting blood sugar should be greater than 5.0 mmol/L (elderly diabetics in poor health should keep it below 5.0 mmol/L).
- Focus on cardiovascular disease prevention. The incidence of cardiovascular disease in diabetics is 2-4 times higher than in non-diabetic people of the same age. Hypertension, dyslipidemia, and abdominal obesity are common in the elderly, all of which are high-risk factors for cardiovascular disease. Therefore, elderly people should focus on cardiovascular disease prevention.
● In addition to blood sugar, you should monitor your blood pressure, blood lipids, and blood coagulation indicators.
● Choose a low-salt, low-fat diet, increase your intake of polyunsaturated fatty acids, and limit your intake of saturated fatty acids and high-cholesterol foods.
- Insulin treatment regimens require careful consideration. As the disease progresses, pancreatic function may gradually decline. If lifestyle adjustments and oral medications fail to achieve target blood sugar levels, insulin therapy may be necessary. Elderly diabetics should note the following:
● Vision should be acceptable, and you or a family member should be able to effectively administer the injection.
● Be aware of the symptoms and treatment options for hypoglycemia.
● Basal insulin is preferred, as it reduces the risk of hypoglycemia. For long-acting insulin analogs injected once daily, it is recommended to be administered in the morning to reduce the risk of nocturnal hypoglycemia.
● Doctors should try to choose treatment plans that are simple and easy to implement.
- Annual health screenings are essential.
High blood sugar isn't a serious concern; complications are. For older diabetics, annual screening for complications is essential for early detection, early intervention, and early treatment.
● Regularly measure blood pressure and blood lipids, and undergo annual cardiovascular disease screening (such as electrocardiograms, Holter monitors, and echocardiograms).
● Lower limb arterial disease is a significant risk factor for diabetic foot ulcers and amputations. Routine lower limb arterial disease screening should be performed annually.
● Regularly test vision and fundus function to screen for diabetic retinopathy.
● Monitor urine routine, urine microalbumin, serum creatinine, and urea nitrogen to screen for diabetic nephropathy.
- Exercise regularly, but in moderation. Exercise helps control blood sugar levels and, more importantly, improves mood and strengthens bones and muscles. Older diabetics should continue to exercise, but in moderation.
● Regularly exercise outdoors. Getting plenty of sunlight helps replenish vitamin D, which facilitates calcium absorption and prevents osteoporosis.
● First, ensure exercise safety to prevent falls. Always carry sugary foods or drinks with you during exercise in case of hypoglycemia.
● Exercise should be done within your capacity. Once you develop a regular exercise routine, it's recommended to exercise for 30 minutes at a time, at least five days a week.
● Combine aerobic exercise (walking, jogging, Tai Chi, dancing, etc.) with resistance exercise (lifting dumbbells, using resistance bands, etc.).
- Sleep management can also help control blood sugar levels.
Poor sleep can affect blood sugar control. Long-term insomnia can increase the secretion of glucose-raising hormones and worsen insulin resistance. Therefore, elderly diabetics should manage their sleep.
● Maintain a regular sleep schedule, avoid staying up late, and avoid sleeping in.
● Avoid strenuous exercise before bed, avoid drinking large amounts of water, and avoid getting up in the middle of the night to disrupt your sleep.
● Maintain a comfortable sleeping environment with a suitable temperature and minimal light stimulation.