Elderly Diabetes Patients on Insulin Most Vulnerable to Low-Blood-Sugar Trouble

HealthDay March 10, 2014

MONDAY, March 10, 2014 (HealthDay News) -- A new look at diabetes patients in the United States who use insulin and wind up in the emergency room with low blood sugar shows the dangerous scenario is more than twice as likely to happen to those over 80 years old.

Not only that, elderly diabetes patients are five times more likely to be hospitalized than younger patients as a result of the low-blood-sugar episode, the study found.

"Managing insulin can be a complex endeavor," said study author Dr. Andrew Geller, a medical officer at the U.S. Centers for Disease Control and Prevention. "We knew it would cause a lot of emergency-department visits for adverse events, but we didn't expect the full severity of these events. Almost two-thirds involved things like passing out and seizures."

For the rest of the story, see HERE.

Ouch; I'm 83 years old and Type 1. This quote is really problematic: "I'm not saying that no one over the age of 80 can benefit from insulin, but every doctor should think twice before they prescribe insulin for someone over 80 because more intensive glycemic control can lead to more hypoglycemia." If you are over 80 and Type 1, you have to have insulin or die, as we all know, and the same is true of some elderly Type 2's. The medical community should think of ways to make taking insulin safer for elderly people, which the article does touch upon.

For what it's worth, my own experience is this: When I was first dx'd in 1993 at the age of 63, I had no guidance at all about how to take insulin, and wound up with a lot of dangerous hypos. In time I had a CDE; she was extremely helpful in teaching me how to manage; then she and my endo helped me get a pump. I tried hard for tight control on my pump and again wound up with too many hypos. My doctors talked me into allowing myself to run a wee bit higher for safety; now I'm on MDI and doing exactly that. Knock on wood, I rarely have serious hypos anymore, enjoy my ice cream! and over the years have never, ever had an emergency room visit or seizure due to a hypo. I credit TuDiabetes with educating me as well, but that's only been the last few years, and unfortunately not all elderly people are using the DOC--maybe there is some way to reach more of them?

The medical community could find ways to help both the elderly and vision impaired PWD's. Medicare and insurance companies could help 100% with the costs involved with visiting nurses and other helpers when they are needed.

I don't mean to downplay your indignation at this article, Trudy. Even the limitations put on resources by Medicare (like CGMs) and the increased paperwork to get what we need is annoying as heck. But I was actually actually pleasantly surprised as to how intelligent this article was. Most articles/commercials, etc about D frustrate me with the number of inaccuracies. I also find that the attitude towards treating the "elderly" is often quite condescending giving them even less credit for intelligence and self sufficiency than the D population as a whole get from the medical community.

But this article acknowledged the complexity we all know insulin use to be, referred to counting carbs to determine mealtime doses, and referred to the problem of confusing short and long acting insulin (suggesting different packaging....great idea!). He does clarify after the statement quoted about "thinking twice about prescribing insulin for people over 80" that Type 1 Diabetics MUST take insulin and earlier mentions that many Type 2's do as well. (especially elderly patients who have had it longer and had more loss of production - my comment). He doesn't mention pumps or cgms which is a big omission imho.

I think encouraging older people to become comfortable with the internet is always a positive thing as then they can come to TuD! It also, in general reduces possible isolation.

I also think a mentor program would be a great idea. Younger PWDs could partner with elderly ones. The younger PWD could visit the older one on an agreed upon schedule and help with anything needed D-wise and the older one could be a great source of information and experience to a newly diagnosed young PWD. They could also connect by phone either routinely or in a crisis if the older person needed assistance from someone who totally understands.

I agree that the bottom line good that can come out of this study is not more limitations but more ways of helping older people in our country (a growing population!) get what they need to manage well both Type 1 and Type 2 D. Starting, in the case of Type 1 is convincing the public that not all Type 1's are 12 years old!

Catherine Price wrote an interesting impassioned response to this piece in A Sweet Life called Why Medicare’s Attitude Toward Diabetes Could Kill Senior Citizens.

ok for a different take, look at my blog this morning about this original article and CGM's. Agree or disagree with me this is a serious issue, agree or not, and of course I hope you do agree with me, this is one heck of a broad issue.

rick

http://www.tudiabetes.org/profiles/blogs/the-case-for-cgms-and-medicare-covered-patients

Hi Rick, I agree with you that Medicare should cover CGM's! Emily's link to A Sweet Life's blog describes the necessity for senior citizens to have accurate testing materials. And the original article by DHF still concerns me for all its information (and the quote I mentioned in my first comment). Let me be clear: I have access to excellent medical care and the means to buy what I need--I am concerned on behalf of senior citizens with Diabetes (those needing insulin face the most dangers)--and of course, our population is always aging.