The results of the DCCT and the UKPDS studies changed lives. They also changed health care practice. Since 1993 we have been carb counting and using basal-bolus insulin dosing (type 1 diabetes). We’ve been starting insulin earlier and/or using a combination of medications (type 2 diabetes). We know the importance of healthy food choices and exercise in managing both type 1 and type 2 diabetes and keeping A1Cs below 7%.
Now that we know what we know, it’s hard to think about backing off on this “intensive management” when we get older. Older people take on new risks as they age (yucky things like decreased hearing, cognitive impairment, worsening eyesight and manual dexterity). If we continue to strive for A1Cs below 7% at this point in life, we risk hypoglycemia, which can lead to falling. While low blood glucose is a nuisance for younger people, it’s downright dangerous for the elderly. Falling could mean breaking a hip or worse yet, there may not be anyone around to help us get up.
It takes the whole team – health care providers, family members and people with diabetes – to accept loosening up blood glucose and A1C numbers in older and elderly people. The trick is to do it in a way that’s not simply “throwing in the towel.” We still want to feel good and have energy, so we don’t want to run high all the time.
This is something to think about as you or your loved one with diabetes ages. And be sure to discuss it with health care providers so you get their buy-in as well. Here are the American Geriatrics Society’ Choosing Wisely treatment guidelines (#3).