Almost a quarter of Americans age 60 and older have diabetes. Numbers of Americans with the disease, which doubles the risk of death, are skyrocketing. Many people with disabilities count diabetes among their issues. However, as common as diabetes is, misconceptions abound.
For example, diabetics can eat sugar. And the formerly termed juvenile-onset diabetes can be diagnosed in the elderly. Diabetes expert Linda Haas, PhC, RN, CDE, who heads up the Older Adult Workgroup at the National Diabetes Education Program (NDEP), talks with Disaboom about the phenomenon.
DB: Why have you called diabetes a “disease of aging?”
LH: The majority of people with diabetes are over 60.
DB: What’s the average age of diagnosis?
LH: Late 50s and early 60s. That’s all types of diabetes. Type 1 represents only five to 10 percent of all diabetes in this country. The majority is type 2, which used to be known as adult-onset diabetes.
DB: Can you get diagnosed with type 1 diabetes late in life also?
LH: Yes, and that’s why they changed the name from juvenile-onset to type 1. It can happen at any age. You can usually tell by looking at someone whether they have type 1 or type 2 diabetes, because the type 1 person is usually very thin, and they’re going to have to take insulin as long as they live, unless they have a pancreas transplant, which is not that common.
The pancreas does a lot more than just make insulin. The surgeon usually takes the ducts that aid in digestion and puts them into the bladder, but to avoid rejection of a transplant you have to take very sophisticated anti-rejection drugs, which in themselves can cause problems.
Plus, there aren’t that many pancreases available. With kidneys, you can have a living, related donor with a relative giving up one kidney, because you can function with only one. But you can’t cut a pancreas in half. Like with liver and heart transplants, the donor has to die.
Diabetes and Heart Disease
DB: We noticed that diabetes is associated with a lot of heart problems.
LH: The largest cause of mortality in people with diabetes is heart disease, and it happens at a younger age than in people without diabetes. Diabetes is considered a risk factor for cardiovascular disease, the same cardiovascular risk equivalent as hypertension, high cholesterol and smoking. It’s in that category. If somebody ‘just’ has diabetes, they’re at risk for heart disease, even if they have normal cholesterol, don’t smoke, and have normal blood pressure. Aspirin is good to prevent heart disease.
DB: And aspirin won’t interfere with the medication of someone with diabetes?
LH: Unless they’re on Coumadin (a brand name for the blood thinner warfarin), but that would be for another reason besides diabetes – but a lot of people with disabilities don’t just have diabetes.
DB: Otherwise, would you say an aspirin a day is helpful?
LH: Yes, particularly in older folks, and definitely if they’ve already had a cardiovascular event, because then you’re looking at secondary prevention. There have been some recent studies that show aspirin is not as cardio-protective as it was thought. So, in younger folks with diabetes who don’t have any other risk factors, the health care community is saying maybe you don’t need an aspirin. But with older folks, most providers are recommending an aspirin whether or not they’ve had a cardio event.
Your Doctor and Diabetes
DB: What are the questions someone should ask their doctor if they’ve just been diagnosed with diabetes?
LH: There are three things:
1. What should I eat?
2. When should I eat?
3. How much should I eat?
Really, the most important question is, ‘Can I see a dietitian?’ Your doctors and even nurse practitioners don’t know that much about meal planning when it comes to diabetes. It’s not, ‘Don’t eat sugar.’ It’s ‘Be consistent with the amount of carbohydrates you eat.’ What’s a carbohydrate? That’s where a dietitian is really very helpful.
DB: So some sugar is okay?
LH: Yes, as long as it’s considered part of a person’s total carbohydrate intake.
DB: Does the source of carbohydrates matter?
LH: Yes, it does, because you have, for example, brown rice instead of white rice. For the same amount of volume, you have less carbohydrates in brown rice. Plus, you’re getting more nutrients.
Aging with Diabetes
DB: What are the differences between someone in their 20s with diabetes, and that same person in their 50s?
LH: A lot would depend on which type of diabetes they have. If it’s type 2 diabetes in their 20s, probably weight loss and increasing their activity are the most important things they can do; they would have early-onset type 2. You can often treat it by losing just five to 10 percent of your body weight. You don’t have to lose 50 or 100 pounds! And by increasing their activity, most younger folks can come off medication, or not start it.
The older person may have had type 1 or type 2 diabetes for a long time and need medication. They may not be able to be as active as the younger person, although there are lots of things they can do even so. For instance, there’s a cable program in Seattle called, “Sit and Be Fit” that has exercises you can do sitting down. The Arthritis Foundation has water exercise programs available throughout the country. If you have joint problems, sometimes working out in the water is an easier exercise than walking or jogging.
See Related Disability Articles:
Is diabetes preventable? Surprising answers.
How do you know if you have diabetes?
