Nov 12

Diabetes

by Dillon Kato

Seniors are the largest group of people with diabetes in the country. According to the American Diabetes Association, more than 26 million Americans have diabetes, and people age 65 and up make up almost 11 million of them, with one in four in that age range having the disease.

The symptoms people should be aware of as possibly being diabetes-related are increased thirst and urination, blurring of the vision, tingling or pain in the feet and occasionally unexplained weight loss.

Diabetes falls into two main versions, Type 1 and Type 2. Type 1, which used to be known as juvenile-onset diabetes, was renamed because it can come at any age. It is also the far less common form of the disease, less than 10 percent of all diabetes patients.

Type 1 is an autoimmune disease, where antibodies attack the pancreas, an organ that creates insulin used turn sugars in the blood into energy. Patients have to use insulin injections to regulate their blood sugar levels.

The more common form is Type 2, which is currently seeing a massive rise in diagnosed cases, and is a strongly genetic disease.

With Type 2, the tissues in the body develop a resistance to insulin, so that the hormones the body secretes are not as effective. A patient’s pancreas is not able to keep up with the body’s demand for insulin, and often times’ the patient has to use oral medication or in advanced situations insulin injections.

If a person has a family history of Type 2, being overweight can increase the risk to develop the disease. If patients over the age of 60 get tested and works with their primary care doctor on lifestyle changes, they can reduce their risk of Type 2 diabetes by about 70 percent, said Lisa Ranes, a certified diabetes educator and a clinical coordinator of the diabetes center at Billings Clinic. She suggested having a fasting glucose test be a part of an annual wellness exam.

Ranes, also a registered dietician, said often times older adults don’t even realize that they have diabetes.

“They might feel tired, have increased thirst and urination, but sometimes the older we get we attribute it to age and don’t get a screening,” she said.

The top priority in prevention is simple, Ranes said, cut calories and move more.

“The more fit we are, the muscles can use insulin better,” she said.

In addition to endocrinologist, Billings Clinic also has a diabetologist, as well as nurse practitioners, physician assistants and social workers who specialize in diabetes.

When working with older patients, they make sure to take into account other health concerns or medications when designing a treatment program.

They also make sure that blood sugar monitors can be easily read by someone with a vision impairment, or that an insulin pen is easy to use by someone with arthritis or dexterity issues.

“A lot of people think diabetes like ‘Oh my gosh, it’s a death sentence.’ It’s 24/7, you don’t get a vacation. But in reality, if you surround yourself with a good team, the complications can be preventable,” Ranes said.

One misconception Ranes has heard is that people with diabetes have to follow a “diabetic diet,” by staying away from sweets and sugars when really, its more about just controlling the carbohydrate intake like everyone should.

“What is healthy for a person with diabetes is a diet that is healthy for average americans. Focus on timing and amounts,” Ranes said.

Having the genes for it, compounded by a lifestyle of a poor diet high in fats and carbohydrates, and not being active enough is increasing the number of people who end up developing diabetes.

“Even though there are more people with diabetes, the complications like the loss of a foot, blindness, are decreasing. Part of that is because we have goals, and we’re getting better about advising people,” said Dr. Christopher Corsi, an endocrinologist with the Western Montana Clinic in Missoula.

When he sees people diagnosed with Type 2, Corsi starts by working with them on modifying their lifestyle to better combat diabetes.

“We can’t fix the genes, so we start by working on the lifestyle choices,” he said.

In the early stages, that means a focus on better diet, more exercise and weight loss, all of which gives the patientbetter control over their diabetes.

Corsi said doctors tend to want to treat Type 2 with lifestyle changes alone, or with oral medications, needing insulin only in advanced cases.

The symptoms people should be aware of as possibly being diabetes-related are increased thirst and urination, blurring of the vision, tingling or pain in the feet and occasionally unexplained weight loss.

If someone comes to his office wondering if they might have diabetes, Corsi said he talks to them about any family history of the disease, but most often can do a simple blood sugar test like the ones people with diabetes use on themselves every day.

For those Type 1 and Type 2 patients who do need insulin, Corsi said technologies are getting better all the time.

“Insulin pumps used to be the size of a backpack, now they are tiny little things. They’ve just gotten better and easier to use,” he said.

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