Senior Health & Diabetes: What You Need to Know for Better Control

November 14, 2023

Diabetes is a multifactorial disease with both genetic and lifestyle contributions. Uncontrolled diabetes leads to significant increase in the healthcare expenditure due to complications of diabetes. According to the International Diabetes Federation (IDF), around 463 million adults were living with diabetes in 2019, with 4.2 million deaths worldwide in 2019 due to diabetes. (1) Diabetes is a disease classically seen in elderly subjects, because with age the pancreatic β cell function declines, hence the insulin producing capacity of pancreas become less.

The prevalence of diabetes in elderly above 65 years is around 22-23 % with high postprandial sugars being a common problem.

Problems with diabetes in Elderly

Diabetes in older subjects is linked to lesser functional status and increased risk of hospitalization due to multiple comorbidities. Due to multiple comorbidities, these patients may have to visit more than 1 doctor due to which there may be overlaps in the prescriptions, or drug interactions which have to be looked into more deeply. Sometimes, due to polypharmacy, patients may have poor adherence to medical treatment- hence the regimens have to be simplified. Elderly subjects have higher risk of falls and fractures- due to neuropathy, muscle wasting and poor vision. Poor mobility, visual and hearing impairment makes them dependent on others. These patients are at increased risk of urinary tract infection which could be a common reason for hospital visits. The elderly diabetic subjects are also at risk for hypoglycemia (low sugars) which could make it difficult to reach the diabetic goals.

Goals of therapy

The Goals of management of diabetes are similar to that of young adults. The fasting blood sugar should be between 80-120 mg/dl and post prandial blood sugar levels should be between 100-160 mg/dl. HbA1C levels should be aimed to keep it below 7%. However, subjects with many comorbidities or frail elderly individuals may have less stringent goals, such as HbA1C values < 7.5–8.0% and postprandial levels < 180 mg/dl.


1. Avoid exercise empty stomach to prevent hypoglycemia.
2. Avoid hypoglycemia at night by eating a bedtime snack like milk, cookies, or fruits before turning in.
3. Patients whose blood sugar levels fluctuate should use the Continuous Glucose Monitoring System (CGMS).
4. Avoid complicated drug regimens to prevent medication errors
5. Social support
6. Evaluation of other systems
a. Cardiac evaluation
b. Eye check-up - to look for diabetic retinopathy and cataract
7. Drug therapy
a. Drugs with do not cause hypoglycemia like metformin, gliptins, …etc should be preferred over drugs which can cause hypoglycemia
b. Drugs with lesser glycemic variability (GV) are preferred


Summary of recommendations

The functional capacity and cognitive function should be assessed in elderly diabetic patients. Treatment plans should be simple and individualized in these patients as per their needs and goals. Drug therapy should be tailored to avoid hypoglycemia. The family and caregiver should be educated and sensitized towards monitoring of sugars and avoiding complications.


1. International Diabetes Federation. Diabetes Atlas 9th Edition 2019.
2. Szoke E, at al. Effect of aging on glucose homeostasis: accelerated deterioration of beta cell function in individuals of beta cell function in individuals with impaired glucose tolerance. Diabetes 2008; 31: 539-543





By Dr Shrinath P Shetty
Dr Shrinath P Shetty is a consultant at department of Endocrinology, KMC Hospital, Mangaluru.
To submit your article / poem / short story to Daijiworld, please email it to mentioning 'Article/poem submission for daijiworld' in the subject line. Please note the following:

  • The article / poem / short story should be original and previously unpublished in other websites except in the personal blog of the author. We will cross-check the originality of the article, and if found to be copied from another source in whole or in parts without appropriate acknowledgment, the submission will be rejected.
  • The author of the poem / article / short story should include a brief self-introduction limited to 500 characters and his/her recent picture (optional). Pictures relevant to the article may also be sent (optional), provided they are not bound by copyright. Travelogues should be sent along with relevant pictures not sourced from the Internet. Travelogues without relevant pictures will be rejected.
  • In case of a short story / article, the write-up should be at least one-and-a-half pages in word document in Times New Roman font 12 (or, about 700-800 words). Contributors are requested to keep their write-ups limited to a maximum of four pages. Longer write-ups may be sent in parts to publish in installments. Each installment should be sent within a week of the previous installment. A single poem sent for publication should be at least 3/4th of a page in length. Multiple short poems may be submitted for single publication.
  • All submissions should be in Microsoft Word format or text file. Pictures should not be larger than 1000 pixels in width, and of good resolution. Pictures should be attached separately in the mail and may be numbered if the author wants them to be placed in order.
  • Submission of the article / poem / short story does not automatically entail that it would be published. Daijiworld editors will examine each submission and decide on its acceptance/rejection purely based on merit.
  • Daijiworld reserves the right to edit the submission if necessary for grammar and spelling, without compromising on the author's tone and message.
  • Daijiworld reserves the right to reject submissions without prior notice. Mails/calls on the status of the submission will not be entertained. Contributors are requested to be patient.
  • The article / poem / short story should not be targeted directly or indirectly at any individual/group/community. Daijiworld will not assume responsibility for factual errors in the submission.
  • Once accepted, the article / poem / short story will be published as and when we have space. Publication may take up to four weeks from the date of submission of the write-up, depending on the number of submissions we receive. No author will be published twice in succession or twice within a fortnight.
  • Time-bound articles (example, on Mother's Day) should be sent at least a week in advance. Please specify the occasion as well as the date on which you would like it published while sending the write-up.

Comment on this article

  • I J S Shet, Mangalore

    Thu, Nov 16 2023

    Greetings dear Dr......Your overview here is very useful and basically helpful. It has good cautions and personal Dr must be consulted when possible. Thanks & regards -ijss.

  • Rita, Germany

    Thu, Nov 16 2023

    Dear Doctor,I find your mentioning about elder subjects?bit unusual.Previously diabetes was hardly unknown to people who work in fields.Its more a modern sickness I find.Even Mettformin is not give the satisfactory effect I found Many People report that it doesnt bring sugar level down Whats the reason ?Anyway Diabetes can be controlled by self by not only eating less sweets but more by moving instead ofgo walking etc.Thank you for your Article.

Leave a Comment

Title: Senior Health & Diabetes: What You Need to Know for Better Control

You have 2000 characters left.


Please write your correct name and email address. Kindly do not post any personal, abusive, defamatory, infringing, obscene, indecent, discriminatory or unlawful or similar comments. will not be responsible for any defamatory message posted under this article.

Please note that sending false messages to insult, defame, intimidate, mislead or deceive people or to intentionally cause public disorder is punishable under law. It is obligatory on Daijiworld to provide the IP address and other details of senders of such comments, to the authority concerned upon request.

Hence, sending offensive comments using daijiworld will be purely at your own risk, and in no way will be held responsible.