This is the third in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.
Diabetes is certainly not a condition that is exclusive to later life. The term is actually an umbrella for a group of related conditions that all have the common feature of a problem of elevated blood sugar. However, there are several factors that are inherent to the ageing process that increase the risk of diabetes as one grows older. The longer you live the greater the likelihood of developing some problems with it.
Medical classifications break it into type I and type II diabetes. Type I usually has its onset in adolescence and results in a more or less complete loss of the ability of the pancreas to produce insulin. Type 1 usually appears in childhood or adolescence, but can appear in adults. Only about 5% of people diagnosed with diabetes have type I. The basic cause is still not fully determined. Treatment usually involves injecting insulin.
Type II is by far the more common form and its incidence has seen sufficient increase in recent years for people to talk about a diabetes epidemic. This term represents a cluster of problems. The two major factors involved are a decreased ability to produce insulin and an increased resistance on the part of the bodily process that use insulin in carbohydrate metabolism. There are a number of characteristics that have been identified as representing risk factors of type II diabetes. Some of the common ones are:
Are over 45
Are obese or overweight
Have family members who have type 2 diabetes
Have low HDL cholesterol or high triglycerides
Have high blood pressure
Some of these factors are things over which a person can exercise some control. That forms an important part of the treatment and management.
Elevated blood sugar is not usually an immediate danger. It can be at extremely high levels. This is usually only seen in people who are insulin dependent. For most people with type II the damage occurs when moderate levels of high blood sugar are allowed to persist over time. The excess sugar can cause irreversible damage to the tissue of nerves and small blood vessels. This damage can result in some serious medical problems such as diseases of the eyes, kidneys and circulatory system. It generally accelerates the ageing process.
Here is a link to the American Diabetes Association and an overview of information on type II. There is a huge amount of online resources on the subject.
At this point I want to move into my personal testimonial about living with diabetes. I was first diagnosed with type II and high blood pressure at the age of 29. That was a long time ago and I am still kicking. There is a history of the condition on both sides of my family which means that I likely have a predisposition to the problem. The exact mechanism of that is not yet well understood. The reason that it caught up with me at such an early age was because I was leading a very high stress and unhealthy lifestyle. I wasn't then nor have I ever been overweight, but I was doing lots of things wrong. With medication the problem was fairly quickly brought under control. I slowly and grudgingly began to make some changes in my behavior. After about a year I no longer needed the medication. It took me 10 years to fully clean up my act and adopt a fundamentally healthy lifestyle. I now look back on that with a certain amount of gratitude.
Age begins to take some toll on almost everybody in middle age, say late 40s to 50s. Having a healthy and productive life beyond that point requires making accommodations in one's habits and lifestyle. The older one gets the more difficult it is for most of us to make changes in the way we do things. Having a persuasive reason to make healthy choices when you are still fairly young has definite benefits to it. The kind of diet and exercise routines that I have learned to practice would stand anybody of my present age (71) in good stead, diabetes or not.
The basic mechanisms for managing diabetes are:
For people who are considered to be pre or borderline diabetic a good consistent program of diet and exercise may be sufficient for successful management without the need for medication. For those who do require medication, D & E can greatly reduce the amount required.
We covered the basics of exercise in last week's diary on arthritis. It is the aerobic part that is important for diabetic control. Not only does it help to speed the utilization of blood sugar, but it also contributes to decreasing the insulin resistance. An hour a day of steady aerobic exercise is a good target to aim for.
A healthy diet for a person with diabetes is not appreciably different from what any adult from middle age onward should be eating. There is likely some extra focus on balancing the carbohydrate load, but there is not some kind of separate special diet for diabetics. I am going to save the topic of diet for another diary, since there is lots to talk about there.
In the 41 years that I have been dealing with diabetes there has been a huge change in the medications that are available. Some of them at times have been controversial because of side effects. I am not going to get into a major technical discussion of them, since that would get well beyond my competence. Here's a link from the ADA. Type II is usually treated with medications that can be taken orally as long as the pancreas has the capacity to produce insulin. Should that fall below a usable level then insulin injections could be required. They have not yet produced oral insulin.
Oral hypoglycemic agents are medications that stimulate the pancreas to produce more insulin. That can speed up the metabolism of blood sugar, but it can also create the condition of hypoglycemia or low blood sugar. Unlike moderately elevated blood sugar or hyperglycemia, hypoglycemia can be immediately dangerous. People taking OHAs have to be alert to this risk and monitor their blood sugar levels and diet.
Metformin is the leading drug for treatment of type II. It is what I take. I have been on an OHA in the past and dealing with hypoglycemia wasn't a lot of fun. Metformin acts on the liver and also works to reduce insulin resistance. For most people it doesn't have major serious side effects. Some of the newer drugs on the market have some issues about side effects. They are generally used as second line treatments when the older types of drugs are insufficient.
The reality about diabetes is that if its management is neglected it can lead to very serious problems. However, for most people effective management that doesn't disrupt your life is entirely possible. I have not incurred any of the complications that can arise from it. I am able to keep my blood sugar level in the pre-diabetic level. Other than the medication I take specifically for it, everything else that I do to manage it contributes directly to my health as an ageing adult.