How to treat diabetes in the elderly

The risk of developing type 2 diabetes mellitusincreases with age. The risk is greatest among adults between the ages of 60 and 74. Elderly diabetes patients who have been exposed to elevated blood sugar level for several years are more likely to experience diabetes-related complications.

How to treat diabetes in the elderly

Moreover, elderly diabetics have a greater mortality risk than their non-diabetic counterparts. They are also more vulnerable to geriatric syndromes such as urinary incontinence, pains, falls, cognitive impairment and depression. Although the diabetes treatment options for the elderly are similar to that for the younger patients, given the delicate health condition of older patients, doctors are more concerned about avoiding drug interactions, hypoglycemia and very low blood pressure in elderly diabetics that may occur during diabetes treatment.

Diabetes Treatment in the Elderly

Nutritional Therapy

Based on the lifestyle and medical condition of an elderly diabetic patient an appropriate diet is planned to meet the daily calorie requirement without boosting the blood sugar level. With appropriate nutritional intervention, the blood sugar level can be easily maintained in the normal range. Obese or overweight elderly diabetics can benefit by restricting calorie intake. They should aim for at least 5 percent reduction in the body weight. However, unintended weight loss is not desirable.

It increases the risk of mortality. Involuntary weight loss should be treated with proper dietary intervention. Due to diverse medical conditions, elderly patients have a higher risk of experiencing under-nutrition. Hence, the diet of elderly diabetics should be tailored to meet their specific nutritional requirements.

Elderly diabetics have a higher risk of nutritional deficiency. They have an especially higher risk of experiencing deficiencies of folic acid, vitamins B1, B12, C, D, calcium, magnesium and zinc. Along with a balanced diet, vitamin and mineral supplements may be needed to improve the nutritional status of the patient.

With age, the daily calorie requirement of a person tends to decrease by 20 to 30 percent. However, the exact minimum daily calorie needs vary according to the body mass index, medical conditions and activity levels. Normally, 20 percent of the daily calorie requirement should be met by protein. The daily protein intake of an elderly person should not be less than 0.8g per kg of body weight. Higher amounts of proteins can be consumed while recovering from infections, injuries and stress.

Sucrose and refined carbohydrates in the diet should be replaced with complex carbohydrates and whole grains. Add sufficient fruits and vegetables to the diet. They will meet your carbohydrate requirement while supplying your body essential nutrients. If you are accustomed to a low fiber diet, gradually improve your fiber intake. Hyperglycemia increases the risk of dehydration. Drink sufficient water and fluid to keep your body hydrated.

Drug Therapy

Most diabetes medications and insulin are considered safe for elderly diabetics. However, the appropriate drug for keeping the blood sugar level under control may vary from person to person. Most physicians recommend low doses of the drug at the initial stage of treatment, gradually changing the dosage over time.


Metformin is usually used as the initial treatment for diabetes. It is usually well tolerated by elderly patients. Since it does not affect insulin production, there is no risk of the blood sugar level falling to very low levels during treatment. However, it is not prescribed to diabetics with cardiac failure or decreased kidney function.

Lactic acidosis is a serious side effect of metformin, which can be avoided by taking proper precautions while using the drug. This diabetes medication may also cause gastrointestinal problems and weight loss. Elderly patients should stop taking the drug and immediately contact their health care provider if they experience any of these adverse reactions of metformin.


Sulfonylurea medication is recommended as an alternative to metformin to patients susceptible to adverse reactions of metformin. Hypoglycemia, a common side effect of the long acting sulfonylurea drug, can be avoided by taking the short acting version of the drug. Risk of hypoglycemia can be minimized by taking meals at regular intervals and limiting alcohol intake.

Sulfonylurea is not recommended for diabetics suffering from cardiac problems, kidney impairment and gastrointestinal disorder. It may interact with certain medications such as warfarin, salicylates, fibric acid and sulfonamides.


Meglitinide is recommended for diabetics allergic to sulfonylurea. However, it is not as effective as sulfonylurea in reducing the blood glucose level.

It is considered safe for diabetics with poor kidney function. Meglitinide intake is least likely to cause hypoglycemia. Weight gain is a common side effect of this drug.


Thiazolidinedione is given to patients intolerant to sulfonylurea drugs. It works by improving sensitivity to insulin. It is safe for people with kidney impairment. As they do not affect the concentration of insulin in the blood, there is no risk of developing hypoglycemia following thiazolinedinedione intake. However, it is not recommended for people with severe heart failure.

Alpha-Glucosidase Inhibitors

This diabetes medication works by slowing down glucose absorption. They are used alone or combined with other diabetes drugs or insulin. It is considered safe for elderly diabetics. It may cause gastrointestinal problems such as diarrhea and flatulence.

DPP-IV inhibitor

Usually DPP-IV inhibitor is combined with other diabetes drugs as it causes moderate changes in the blood sugar level when used alone. As there is no risk of hypoglycemia and weight changes following DPP-IV monotherapy, it is considered safe for elderly diabetes patients.


In elderly people with mild to moderate diabetes, GLP-1 analog drugs can be used as an adjunct to nutritional therapy and lifestyle modifications to keep the blood sugar level under control.

These drugs are safe for elderly patients. They do not cause hypoglycemia. Weight loss, vomiting, nausea and diarrhea are possible side effects of the drug. It is not recommended for people with high urine creatinine level.


Insulin therapy can cause significant improvement in the quality of life of elderly diabetes patients. Long-acting insulin is taken alone or combined with oral diabetes drugs to keep the blood sugar level under control. Elderly people who cannot administer the insulin shot on their own will require help from a family member, caregiver or pharmacist. Your physician will take into account the condition of your kidneys while prescribing the appropriate insulin dose.

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