Why older people may not have to observe the level of blood sugar so carefully

Until now, Ora Larson recognizes what is going on. “You seem to shake yourself inside,” she said. “I’m accelerated. I’m restless. ” If someone asks if he would like lunch salads, they don’t know how to answer.

This year she had several such episodes and it seems that they come more often.

“He looks and has a gray color, and then she is confused,” said Susan Larson’s 61 -year -old daughter. “It’s really scary.”

Hypoglycaemia occurs when blood sugar or glucose levels fall too low; Reading below 70 milligrams on the deciliter is a accepted definition. It can affect anyone who uses glucose lowering drugs to control this condition.

But it occurs more often at an advanced age. “If you have been diabetes for years, you probably experienced an episode,” said Dr. Sei Lee, Geriatric from the University of California in San Francisco, who examines diabetes in the elderly.

Venerable Mrs. Larson, 85, has type 2 diabetes for decades. Now her endocrinologist and primary care doctor are afraid that hypoglycaemia can cause falls, broken bones, heart arrhythmia and cognitive damage.

They both advised her to allow her a1c hemoglobin, the measure of average glucose in the blood in a few months, increased 7 percent. “They say:” Don’t worry too much about ups – we want to prevent falls, “said younger Larson.

But her mother spent 35 years, working on maintaining A1C below 7 percent – a universal recommendation, a goal for which people sing and dance in pharmaceutical commercials.

He faithfully injects the prescribed drug, Victoza, about three times a week and observes her diet. He is the oldest member of Aqua for arthritis classes at the local pool in St. Paul, minn.

So when her doctors recommended a higher A1C, she resisted. “I think it’s a Hooey group,” she said. “It didn’t make sense to me.”

“She had many incentives and recognition from her doctors for controlling diabetes, remaining at the top,” her daughter explained. “They always praised her” tight control “.

“For someone who has been so compatible throughout all these years, it is as if they changed their rules.”

In fact, they have.

More than a decade ago, American Geriatrics Society called to hemoglobin A1C from 7.5 to 8 for most older adults with diabetes and from 8 to 9 percent for people fighting many chronic diseases and restricted life expectancy. (Older lady Larson has multiple sclerosis and hypertension.)

Other medical societies and groups of spokespersons, including American Diabetes Association and Endocrine SocietyThey also changed their guidelines up for older patients.

Relaxation of aggressive treatment may include stopping the drug, lowering the dose or switching to another medicine-called de-intentification.

The emergence of effective up-to-date drugs for diabetes-diabetes GLP-1 (such as OZEMPIC) and SGLT2 inhibitors (such as Jardiance)-a more changed the landscape. Some patients can replace these safer drugs with risky elderly.

But up-to-date drugs can also complicate decisions, because not all older patients can change – and for those who can, insurance companies can examine up-to-date medicines at high prices and refuse protection.

So development is continued, but too gradually.

2021 Medicare Beneficiary study with diabetesFor example, he looked at patients who went to the ambulance or were hospitalized because of hypoglycaemia. Less than half had their drug schemes within 100 days.

“Residents of nursing houses They are those who get into trouble, “said Dr. Joseph Ouslander, Geriatric at Florida Atlantic University and editor -in -chief of the Journal of American Geriatrics Society.

Another 2021 study of nursing homes in OntarioHe stated that more than half of the inhabitants taking drugs for type 2 diabetes had A1C levels below 7 percent. People with the greatest cognitive disorders were treated most aggressively.

Dr. Ouslander calculated, based on domestic examinationthat about 40,000 visits to the ambulance results from excessive treatment of diabetes in older adults in 2007–2011. believes that the numbers will probably be much higher now.

Tiny foundation: Diabetes can cause such severe complications-fucked hearts, stroke, vision and hearing loss, chronic kidney disease, amputations-so-called strict glucose control makes sense at a youthful age and middle age.

But strict control, like any treatment, covers the period before paying off better health. In the case of diabetes, this is a lot of time, probably from eight to 10 years.

Older people who are already fighting various health problems may not live long enough to take advantage of strict control. “It was really crucial when you were 50 years vintage,” said Dr. Lee. “Now it is less crucial.”

Older diabetics do not always welcome this message. “I thought they would be elated,” said Dr. Lee, but they were pushing. “It’s almost like I was trying to take something from them,” he added.

The risk that strict control will also escalate hypoglycemia as the patients aged.

It can make people sweat, panicked and tired. When hypoglycemia is sedate, “people can lose consciousness,” said Dr. Scott Pilla, an internist and diabetes researcher at Johns Hopkins. “They can become confused. If they lead, they may have an accident. “

Even milder hypoglycemic events “can become a qualifying problem of life, if they often happen”, causing fear He added that in patients and possibly leading them to limit their activity.

Experts point to two types of older drugs particularly involved in hypoglycaemia: insulin and Sulfonylcoms Like Glyburide, Glipizide and Glimepiride.

For people with type 1 diabetes whose bodies cannot produce insulin, hormone injections remain necessary. But drugs “are widely considered a perilous drug” due to its risk of hypoglycemia and should be carefully monitored, said Dr. Lee.

He added that sulfonylcoms “are becoming less and less used” because, although less risky than insulin, they also cause hypoglycaemia.

The immense majority of older adults with diabetes have type 2, which gives them more options. They can supplement the commonly prescribed metformin with newer GLP-1 and SGLT2 drugs, which also have the benefits of heart and kidneys. If necessary, they can add insulin to their schemes.

However, among the more popular consequences of up-to-date drugs is weight loss.

“For the elderly, if they are breakable and not very busy, we do not want them to lose weight,” noted Dr. Pylla. Both metformin and GLP-1 and SGLT-2 drugs may have gastrointestinal or sexual side effects.

For 15 years, 69 -year -old Dan Marsh, an accountant in the media, PA., Treated his type 2 diabetes, injecting two forms of insulin a day. When he takes too much, he said, he wakes up with “damn falls” at night and has to eat and take glucose tablets.

However, his A1C remains towering, in last year the doctors amputated part of the finger. Because he takes many other drugs for different conditions, he and his doctor decided not to try different diabetes medications.

“I know there are other things, but we didn’t go that way,” said Marsh.

With all up-to-date options, including continuous glucose monitors, “determining the optimal treatment is becoming more and more complex,” said Dr. Pylla.

To sum up, “older people overestimate the benefit of lowering blood sugar and will not appreciate the risk of their medications,” he said. Often, Their doctors did not explain how compromises change in old age and collecting health problems.

Ora Larson, who brings glucose chewing pills in the case of hypoglycaemia (fruit juice and bars are also popular antidots), intends to talk about treating diabetes at doctors.

It’s a good idea. “Hypoglycemia is the greatest risk factor for severe hypoglycemia,” said Dr. Lee.

“If you have one episode, it should be considered a warning signal. The document is to determine why it happened? What can we do to make your blood sugar level not dangerously low? “