Diabetes in old age

1. Avoid hypoglycemia: particularly important for older people
2. Blood sugar target values in old age
3. Adapting medication to age
4. Finding the right insulin therapy
5. Blood pressure and blood lipids under control
6. The problem of multimedication: several medications at the same time
7. In need of care with diabetes
8. Aids for the treatment of diabetes

To avoid low blood sugar levels with type 2 diabetes, healthcare professionals may need to adjust treatment with oral antidiabetic drugs. Medication that minimizes the risk of low blood sugar levels is preferable.  

Due to their increased risk of low blood sugar levels, antidiabetic drugs from the sulphonylurea group are considered less suitable for older people with diabetes. In the case of combination therapy with several antidiabetic drugs, side effects are also more likely to occur in old age and must be taken into account. 

To treat type 2 diabetes in old age with medication, metformin is often prescribed. However, metformin should be discontinued if renal function is impaired (glomerular filtration rate of less than 30 milliliters per minute) or in situations where impaired renal function is expected. This should, for example, be done in case of infections with fever or an operation with general anesthesia.  

Before surgical procedures and generally during hospital stays, people with diabetes should always inform the hospital staff about the medication they are currently taking. 

Good diabetes management is often a challenge for people in need of care. The focus is usually on preventing low blood sugar levels and long-term diabetic complications such as diabetic foot syndrome. 

Depending on the severity of the diabetes, family caregivers are often required to have a high level of knowledge about the disease. If caregivers or caregiving relatives take over parts of the therapy, it is important that they are appropriately trained. The German Diabetes Association offers further qualifications as a “Diabetes Care Specialist DDG for Long-Term Care” and the "Basic Qualification Diabetes Care DDG". When moving into a retirement home, relatives should find out whether appropriately trained staff are available. 

It is also important that the attending physician and those involved in the care are in contact with each other. This enables both parties to better assess the potential risks of the treatment for the patient and adjust the therapy if necessary. 

In addition, the following must be taken into account for patients with diabetes: 

Nutrition 

In the case of diabetes in particular, malnutrition can occur at an advanced age if those affected eat too little and therefore absorb too few nutrients. A balanced diet is important. If necessary, a diet plan should be drawn up with the attending physician. 

Skin and Foot Care 

People with diabetes have an increased tendency to skin damage and skin diseases. Good skin care is therefore essential. Because a common complication of diabetes is the diabetic foot, caregivers should look at the feet daily, check for skin changes and ask about sensory disturbances and pain. It also makes sense to hire a medical pedicurist to remove calluses and cut your nails. The costs incurred in this case are covered by health insurance. 

Oral Health 

Diabetes is associated with an increased risk of infection and often also severe periodontal disease. Special attention should therefore also be paid to oral health.  

Danger of Falling 

Limited balance, diminished vision and a reduced ability to react – especially in the case of low blood sugar levels – further increase the risk of falling in old age. Preventing falls is therefore particularly important. Tripping hazards (e.g. slippery carpets etc.) must be removed. The patient should also be provided with suitable footwear and, if necessary, suitable glasses and possibly a walking aid.

Applying for a Care Level for Diabetes 

If there is a need for care due to diabetes, an appropriate care level can be applied for. In addition to diabetes, the care assessment also evaluates age, mobility, cognitive abilities, self-care and the severity of additional illnesses or diabetes-related complications. 

The care assessment is carried out by the Medical Service of the statutory health insurance. For those with private health insurance, this task is performed by the “Medicproof” service provider. The result of the care assessment is used by the health insurance provider to recognize or reject the care level for diabetes. If recognized, the following benefits can be claimed depending on the care level: 

• Care allowance (for example, care by relatives or friends) 
• Care benefits in kind (e.g. outpatient nursing service) 
• Full inpatient care (for example, accommodation in a nursing home) 

An individual care plan should be drawn up for every patient with diabetes who is cared for at home, in part-time or long-term inpatient care. This plan describes the necessary care measures and therapies in detail. 

Various aids can make everyday life easier for older people with diabetes. These include, for example: 

• Blood sugar meter with a large display or voice function. 
• Measuring devices that store the values automatically. 
• Continuous glucose monitoring systems (CGM systems), which use a sensor on the arm or stomach to continuously measure tissue glucose levels and issue alarms to indicate high or low levels. 
• Easy-to-use insulin pens or insulin pumps. 
• Anti-slip socks protect against falls. Hip protection pants can help to prevent injuries. 
• A watch or cell phone app that reminds you to take medication or insulin. 
• Medication dispenser.