Trudy,
Type G:) Great to have a good doctor who ran tests.
My fasting BG was always normal from annual labs. I can only guess what postprandial was because I crashed & almost died from DKA.
This "Pre-diabetes" condition is a murky area. It's scary to think of how many people have a problem without even knowing it. With respect to Type Geriatric, I believe that doctors should routinely check for it, which appears to be simply the beta cells dying out from age; but what age does it usually start? For the patient, it can be so easily confused with just growing older.
I LOVE the term "Type Geriatric"!!!! I DO believe it exists, and is just one of several types that simply haven't been recognized. I have a friend, age 86, who is emaciatedly thin, but was told she had Type 2 diabetes, and to limit her carbs and carefully measure out her other foods. A TYPICAL T2 weight-loss oriented diet! And weight loss is the LAST thing she needs! I honestly don't think, at her age, potential complications in the future are the main worry -- what matters is keeping her in the best possible health RIGHT NOW. A couple extra pounds might get her through an illness when she couldn't eat, whereas as it stands now, she has exactly NO energy surplus to spare. Of course, she listens to her doctors -- she's of the generation that trusted them implicitly, so she won't listen to me, but I really think the special needs of the elderly, at least those over the age of 75 or 80 should be taken into account!
Thanks, Natalie!
And thanks, Alan, for this important question.
Hi Gerri. Yes, we are so lucky with our medical team, which we share to some extent. Just the thought of DKA is so scary, sorry you had such a close call.
Not that most doctors do right by very young & adult diabetic patients, but they sure don't know what to do with senior diabetics. For one thing, we didn't used to live that long to make it into their outdated education.
An emaciated woman on a weight loss regiment--sigh. Doubtful that her doctor told her to limit protein since most don't even understand how that impacts BG. Do you think she'd listen if you told her to increase protein? Increased protein will help her gain weight, or at least not lose any.
I did talk to her both about increasing carbs and protein. I saw her log book, and she's NEVER above 120 on the diet she's been following, and she could afford a little bit higher BGs if it meant putting on some weight. But she really didn't seem to want to change what she was doing, so I dropped the subject.
One thing that disturbs me is that I have heard CDEs talk about elderly diabetics, and insist that they be treated the same as everyone else, with the same goals. But I'm not so sure that should be the case. While I can't predict my friend's life expectancy, I just can't see the rationale behind such tight control at the expense of needed calories.
I dunno -- maybe I need to see what I can find out about diabetes in the very old -- maybe I'll be one some day (64 on March 7!!).
Fat & protein are very calorie dense. The problem is that if her BG gets too high, she won't gain weight.
I respect that CDEs have the same goals for elderly patients. Too often, medical professionals have horribly lax attitudes towards older patients in general. Many older people have high BP. Increased BP with high BG are high risks for stroke. Throw in the other risk factors associated with high BG & I understand their stance.
You do have a point with the observation about hypertension. But I do think that the geriatric population (which is going to explode -- we Baby Boomers are coming!) is a special needs population that needs specialized knowledge, thinking and goals. And I'm not sure that having the same goals for a 30-year-old as for an 80-year-old is necessarily appropriate. In my own case, yeah, I'm insulin dependent, and that won't change, but my friend is not on any medications at all, and if she had 150 or 160 post-prandially, would that hurt anything? I don't think she needs to stay below 120 at all times, even though *I* would like to be able to do that, LOL! Anyway, it's her life, and her decisions, and she's a smart lady, so I leave it in her hands.
I think over 140 could potentially harm her more than it would a younger person. I'm against lower standards for anyone:)
Darn!! There goes my plan to start eating nothing but angel food cake and ice cream when I turn 80 (I should be so lucky)!!!!! :-)
Does she write the right numbers down in her log book? My grandma didn't have D but sort of avoided going to the doctor for a different problem, didn't eat (which aggravated the problem...) and ended up dying of it. I think that some people in successful cohorts (having exceeded life tables for their group...) sort of run their own show. Not dissimilar to people with diabetes having to run their own show. I considered "forging" a logbook to get a pump but when I sat down to do it, I started spinning threads of fiction all over the place and realized that it would be more time-consuming than just plain logging. I could see someone with perhaps additional time on their hands, who realized the consequences-- the "you've been very naughty" lecture from the doc-- might choose to just write down some decent numbers?
I also agree with Gerri that the consequences of "off" numbers or getting pulled into an off-number lifestyle would likely be more severe in someone who's older. I would think that people in the older cohorts are already having eye problems, feet problems (including balance and stability problems), digestive problems and other things that don't perhaps work quite as well as they used to and, if you add diabetes' propensity to trash things that are a little bit off in, it is a grim combination.
I had better start smoking...