Diabetes: Symptoms, Testing and Risk Factors

Lars and Teresa, both 81, fell ill and were hospitalized at the same time. Lars has diabetes and heart problems but is normally healthy enough to care for Teresa. Although Teresa is physically stronger than Lars, she has moderate dementia and requires help with most activities.

After recovering from her illness, Teresa was transferred from the hospital to a rehabilitation center until Lars was discharged from the hospital. The couple’s only living child lives over six hours away and is in poor health. Teresa and Lars live independently in their home without assistance.

Lars and Teresa are now both home, but Lars is struggling to manage their care. He is especially concerned that he might miss one of his or Teresa’s medications, sending them back to the hospital. Lars’ diabetes has been well-controlled until his recent illness. As he recovers from his illness, Lars is having difficulty preparing meals and performing routine household tasks. He avoids unhealthy fast-food meals whenever possible.

Many adults have diabetes and don’t know it.

As of 2018, the Centers for Disease Control and Prevention reported that diabetes affects 8.2% of the U.S. population, about 26.9 million people. Between 22% and 33% of U.S. adults over the age of 65 have diabetes.

Because many adults have high blood glucose levels after eating, they are not diagnosed when standard fasting blood tests are used. Approximately 88 million Americans, which is more than a third of all U.S. adults, have prediabetes, and about 84% are not aware they have it. The American Diabetes Association recommends that all adults over the age of 45 be screened for diabetes every 1-3 years.

A family history of diabetes and aging are both risk factors for type 2 diabetes. Other risk factors include being sedentary, being overweight or obese, or having a physiologic stress such as an infection. Eating healthily, taking medications, and getting enough support to feel comfortable exercising can be challenging for some older adults.

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What is the difference between type 1 and type 2 diabetes?

Diabetes is a group of disorders that all result from difficulty controlling blood sugar. When food is broken down in the stomach and intestines, glucose and other sugars are absorbed into the bloodstream. Blood sugar levels must be tightly controlled by the body because glucose and other sugars are the primary energy source for all cells.

The hormones, insulin, and glucagon are released from the pancreas to regulate blood glucose levels. When your blood glucose levels are too high, your pancreas secretes insulin, a hormone that transports glucose from the blood into the cells, where it can be used as a source of energy. When your blood glucose is too low, glucagon is released from the pancreas.

Type 1 diabetes:

Due to an autoimmune disorder, the body’s immune system destroys the pancreas tissue that produces insulin. Without the ability to produce insulin, a person with type 1 diabetes depends on insulin injections.

Type 2 diabetes:

In type 2 diabetes, your body’s cells are not responding correctly to insulin. The pancreas will compensate for a while by pumping out more and more insulin, but eventually, it cannot keep up, and your blood glucose levels begin to rise.

How do you know you are developing diabetes?

There is a constellation of symptoms associated with diabetes, including:

• Frequent urination: When your blood glucose is too high, some glucose will be excreted in the urine. The excess glucose drags water into the urine, which results in an increased volume of urine.
• Increased thirst: As more urine is produced, your body can become dehydrated, which triggers dry mouth and increased thirst.
• Blurred vision: High blood glucose can cause changes in the lens of the eye, a structure that helps with focusing an image. Blurred vision resolves when blood sugar levels return to normal.
• Fatigue: Blood glucose in the bloodstream and not in the cells, coupled with dehydration, makes it hard for the metabolic processes in your body to run well, causing fatigue and low energy.
• Slow healing: Increased inflammation, increased blood glucose, and damage to the lining of small blood vessels make it difficult for body tissues to get the nutrients and oxygen they need to heal.
• Increased hunger: When the cells in the body are not getting the energy they need to function correctly, they signal the brain to increase your appetite.

Tests for Diabetes

Fasting blood glucose and glucose tolerance tests are two methods for diagnosing diabetes.

Fasting Blood Glucose

A fasting blood glucose is a simple blood test that is obtained first thing in the morning or after an eight-hour fast.

• Optimal: less than 100 mg/dl
• Prediabetes: 100 to 125 mg/dl
• Diabetes: 126 mg/dl or higher

Hemoglobin A1C

Hemoglobin A1C (HbA1C) can also screen for diabetes by providing an average blood sugar for the previous three months. A healthy HbA1C level is less than 5.7%. A HbA1C between 5.7% and 6.4% is classified as prediabetes, and over 6.5% is diabetes.

The American Diabetes Association suggests that everyone should strive to have a blood glucose under 7%, leading to a lower risk of blood vessel damage.

Glucose Tolerance Test

For a glucose tolerance test, you will drink a sugary liquid after fasting overnight and have your blood sugar checked. A blood sugar of 140 mg/dl or less at two hours is considered normal.

Does diabetes worsen with age?

The incidence of diabetes increases with age until about age 65, after which it levels off. Older adults with diabetes have a higher incidence of major low-extremity amputations, heart attacks, visual impairment, and end-stage kidney disease. The rate is even higher in those aged 75 and older.

How long do people with type 2 diabetes typically live?

In a study from the U.K., experts found that the average person with type 1 diabetes at the time of the study was 42.8 years of age and was expected to live another 32.6 years (compared to 40.2 years without diabetes) — a loss of 7.6 years.

The average person with type 2 diabetes was 65.4 years old and had a life expectancy of 18.6 years (compared to 20.3 years for someone without diabetes) — a loss of 1.7 years. The younger you are when diagnosed with type 2 diabetes, the greater the impact on your life expectancy.

How does contracting a virus affect diabetes?

Having diabetes can make you more susceptible to viral infections and increase your risk of serious complications. Poor circulation and a weakened immune response are both risk factors for a more severe viral infection and are both more common in people with diabetes.

How can home healthcare help you manage your diabetes?

Lars and Teresa were both recently discharged from the hospital after being treated for viral infections. Lars is caring for Teresa while also dealing with his own illness. His blood sugar has become more difficult to control since he became ill.

Lars is aware that he is at a high risk for complications from his infection and that he may need to be hospitalized if he does not take care of himself. If he is hospitalized, Teresa will need to be readmitted to a long-term care facility, a situation neither of them wants.

When Lars was discharged, home health visits were organized for him, but they could not provide the number of visits or support that Lars felt he and Teresa needed to stay in their home.

Lars contacted Sunland Home Care & Medical to arrange for both home-based medical care services and in-home services. They were able to provide the support he and Teresa needed until they fully recovered.