Diabetes is a hot issue in healthcare today. Treating diabetes is incredibly expensive--according to the American Medical Association, one of every three Medicare dollars is spent treating it. Since diabetes is more likely to occur as we age, understanding diabetes as a disease, knowing how to prevent it, and knowing how to treat it are vital as we care for an aging population in America.

The Biology of the Disease

Type 1 diabetes is an autoimmune disease where the body's immune system attacks the pancreas, specifically the cells which produce the chemical insulin. Since insulin seeks to get glucose into cells in order for them to attain energy, an absence of insulin leads to cell death. It can develop at any age, but Type 1 is sometimes referred to as "juvenile diabetes," because it is often diagnosed when patients are young.

Type 2 diabetes is sometimes called "adult onset diabetes" because it is more often diagnosed in adults, and is not an autoimmune disease. The body does not attack itself, but the pancreas produce less insulin than is necessary for the body to process glucose. Because of this, blood sugar levels are high. This type of diabetes is often linked to sedentary lifestyles and obesity. Both of these are risk factors because they affect blood pressure and the body's ability to produce insulin properly.

Preventing Diabetes

Preventing Type 2 diabetes is the pressing issue, since Type 1 is the result of an autoimmune disorder that cannot be altered by lifestyle or diet changes. Studies from the Centers for Disease Control's (CDC) Diabetes Prevention Program showed that people can delay and prevent Type 2 diabetes "by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating."

Physical impairments can make exercise a huge obstacle...

This poses a problem for many caregivers and seniors. Physical impairments can make exercise a huge obstacle, or a huge risk for further injury. A woman with osteoporosis, for example, needs to take care not to risk breaking weakened bones, and thus may see something as simple as walking around the park as a dangerous task.

Changes may be complicated for those with dementia and other cognitive health issues. Making lifestyle changes can disrupt routines and dissolve good days into bad days. So prevention is a caregiving team issue, including doctors, all those involved in daily care, and the seniors themselves.

Prediabetes

Prediabetes is a diagnosis that warns patients that they are on the edge of developing Type 2 diabetes. Their blood sugar levels are high, but not high enough to settle them into the category of diabetes diagnosis. Patients may have no symptoms, but those who are diagnosed with it can begin the prevention methods discussed above and potentially stave off the development of Type 2 diabetes indefinitely. It is vital that you, as a caregiver, ensure that your loved one is tested for prediabetes because this will help the person get treatment more quickly. Since it has no symptoms, you should look for risk factors such as obesity, high blood pressure, and being sedentary (remaining seated or lying down for most of the day).

Treating Diabetes

Type 1 is treated through insulin injections, primarily. The patient tests their glucose levels using an external device, and they inject insulin according to their numbers and their planned glucose intake. There are some advancements in this field, however, that make it even easier for patients and their caregivers. Insulin pumps and readers now can read glucose levels in real time and continuously inject or withhold insulin, acting as a sort of external pancreas. These are often attached to the abdomen and can be connected--amazingly!--to applications on smartphones, which will alert the patient or their caregiver if glucose levels are dangerously high or low. (This is especially useful if your loved one has difficulty speaking or injecting insulin, or suffers from memory issues, forgetting food ingested or neglecting to test blood sugar levels.)

Type 2 treatment depends upon the patient. Some many require insulin injections, like Type 1, because they produce little insulin naturally. Others may be prescribed only lifestyle changes, like a healthier diet or more exercise. In general, the Mayo Clinic recommends fruits, vegetables, and whole grains, and avoiding "animal products" (meat, eggs, milk, cheeses), carbs, and sweets. They also say that exercise will make huge changes (this is backed up by the CDC's study as well), even if it is as small as 30 minutes a day.

All diabetes patients need to regularly monitor their blood sugar, as very high or very low levels can cause catastrophic results, such as renal failure, blindness, and nerve damage.

Sources

American Medical Association. Diabetes Prevention. Available at http://www.ama-assn.org/ama/pub/advocacy/topics/diabetes-prevention.page. Retrieved 1/19/2016.

Centers for Disease Control. Preventing Diabetes. Available at http://www.cdc.gov/diabetes/basics/prevention.html. Retrieved 1/19/2016.

Mayo Clinic. Type 2 Diabetes. Symptoms and Causes. Available at http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/dxc-20169861. Retrieved 1/19/2016.

Diabetes Teaching Center at the University of California, San Francisco. Diabetes. Insulin Administration. Diabetes Education Online. Available at http://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/insulin-administration/. Retrieved 1/19/2016.

Bionic Pancreas Team. Boston University and Massachusetts General Hospital. Bionic Pancreas. Available at http://sites.bu.edu/bionicpancreas/. Retrieved 1/19/2016.

Diabetes Research Institute. What is Diabetes? Available at http://www.diabetesresearch.org/what-is-diabetes. Retrieved 1/19/2016.

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