Diabetes in Seniors: UK Challenges and Care Approaches (2024)

Diabetes in older adults is becoming more common in the UK.

With other comorbidities, like cardiovascular disease and conditions that affect mobility, it can be difficult for older adults with diabetes to properly care for themselves.

This post will shed some light on the challenges associated with diabetes in seniors and some pointers to help make the condition more manageable.

Half the people diagnosed with diabetes in the UK are over 65 years old. The stats also show that 10% of people over 75 years and 14% of those above 85 years have diabetes, according to the BGS .

Diabetes occurs because of several contributing factors working together. These include a high body mass index (BMI), constant stress, an unhealthy diet, and a sedentary lifestyle.

However, one of the biggest contributors to diabetes is natural ageing, which is why it’s so prevalent among the older population.

These risk factors apply to type 2 diabetes which causes insulin resistance alongside reduced insulin production. Meanwhile, type 1 occurs because of an abnormal genetic mutation that causes the body to attack pancreatic cells secreting insulin.

Both types can be seen in younger and older people, however, type 2 is more prevalent, constituting around 90% of all the cases.

Diabetes is more difficult to control for older people primarily because of comorbidity , which means the presence of more than one illness at the same time, which is a common occurrence in older age.

The factors leading to its prevalence are:

As we age, we’re more likely to develop more than one chronic condition. This is usually the result of genetic changes that cause cell ageing and death.

Heart diseases, arthritis , and dementia are among the conditions that develop as we age. When multiple illnesses are present simultaneously, complications of diabetes, like retinopathy , neuropathy, and hypoglycaemia, become more likely to happen.

The expression ‘polypharmacy’ refers to the multiple medications needed to control chronic diseases, which are common with older adults.

Typically, a doctor will find it much easier to prescribe medication for a person who doesn’t take too many medications, as this reduces the risk of drug interactions to a minimum.

A person living with diabetes ideally shouldn’t take any medication that can increase their blood sugar levels, including most antidepressants, beta-2 stimulators, and corticosteroids.

Note: While not a replacement for a doctor’s consultation, a reliable drug interaction checker like the ones provided by WebMD or Medscape can help you decide whether a medication is safe in case of an emergency or doctor unavailability.

Age-related decline in cognitive functions can make it even more challenging for older people to manage their diabetes.

The presence of a cognitive impairment can make it harder for an older person to read blood sugar levels, inject insulin, or independently follow instructions for diabetes management.

Seniors are more prone to sensory and physical impairments, which can lead to trouble maintaining a diabetes care routine even if they’re dedicated.

Many tasks like monitoring blood sugar, preparing healthy meals, medications that need tracking, and regular exercise can be more difficult to stay on top of, leading to poorly-handled diabetes.

Metabolic activity, including the ability to break down ingested food and produce and use insulin, naturally decreases with age .

Suppose people in their 30s could regulate their blood sugar by monitoring their meals. They’ll need stricter monitoring when they’re older because of the further reduced insulin sensitivity and physical activity associated with aging.

It’s not uncommon for older people to be isolated in their homes. A large aspect of managing diabetes comes from social and familial support. Without it, seniors may be less likely to adhere to their treatment plan or seek help when needed.

This isolation can also contribute to some psychological factors. Depression, anxiety, and other mental health conditions are commonly found along with diabetes in seniors . Such conditions make it harder to cope with the already challenging sides of managing the disease, leading to poor diabetes control.

The NHS’s annual budget for fighting diabetes has increased in the past few years. The York Health Economic Consortium, or YHEC, expects that, over the next 25 years, the annual budget will increase from £9.8 billion to £16.9 billion , according to projections.

The UK government is sparing no effort in providing help, support, and education about diabetes. Those who can use the internet may visit the Diabetes UK official website , where all information that they can use to fight diabetes is available for free.

There are also two helplines available, one that covers England, Wales, and Northern Ireland (0345 123 2399) and one that covers Scotland (0141 212 8710). Their emails, respectively, are helpline@diabetes.org.uk and helpline.scotland@diabetes.org.uk .

There is also the Silverline, which is a 24-hour telephone support specifically for older people. Both the official website and the phone number (0800 4 70 80 90) are available around the clock.

Silverline is especially helpful for seniors who feel alone or isolated, as it provides friendly conversations around the clock.

The NHS DPP was launched in 2016 to prevent diabetes. Between 2018 and 2019, the program reduced the number of new type 2 diabetes cases by 7%.

Enrollees of the program are not just a number-they receive personalized lifestyle advice tailored to their needs. This includes exercise schedules and dietary plans, all designed to help reduce the risk of diabetes.

According to the NHS, 200,000 people a year will be able to access and benefit from the DPP, which can help reduce the population's diabetes risk even more.

The optimum diabetes care for older people can be divided into multidisciplinary care and monitoring and managing diabetes with technology.

Among the biggest difficulties the older population with diabetes faces are comorbidities and polypharmacy, which is why multidisciplinary care can be a helpful approach.

This approach involves a team of professionals from multiple disciplines working together to provide coordinated care for the older patient.

This team can include doctors, nurses, therapists, social workers, and even volunteers. When all physical and emotional aspects of the person’s health are addressed, the quality of life should significantly improve.

This coordination also improves the overall prognosis and gives the older patient sufficient mental energy to keep up with their medication.

Multidisciplinary care often includes the following modalities:

• Pain and Symptom Management: Early signs of complications like foot pain or numbness, blurry vision, or suboptimal random plasma glucose test or oral glucose tolerance test results are addressed to prevent worsening symptoms.

• Psychological Support: Chronic conditions like diabetes can cause anxiety and depression, especially if the patient is isolated. The team can provide people with the mental health support they need to cope with these challenges.

• Education: Older patients and their families should be educated about the condition and the treatment options. This helps them make informed decisions about what they should do when it comes to treatment options.

Monitoring and managing diabetes is becoming easier with technological advances. Modern devices have allowed all people with diabetes to monitor their blood sugar levels from the comfort of their homes.

Keeping blood sugar levels within the desired ranges is the prime target of diabetes management, regardless of whether it’s type 1 or 2. The following devices made this process much easier:

Glucose metres are the quickest and most accurate blood sugar measuring devices. They take a small blood sample through a finger prick, then insert the sample on a strip into the glucose metre.

Within seconds, the results will show up, making it unnecessary to go to the doctor or clinic every time you require a blood sugar test.

Continuous glucose monitors, or CGMs, work by measuring the glucose levels within the fluid present between the cells in the skin's sublayer. Their primary advantage is their constant updates on blood sugar levels, making them especially effective for seniors with diabetes.

For example, if an older person cannot test their blood glucose using a glucometer for any reason, all they have to do with a CGM is to look at the results on the display screen, which can be their phone or a dedicated receiver screen.

The screen gets the results from a sensor planted under the skin and covered with a patch. Depending on their type, these sensors can last anywhere between weeks to months, providing another advantage: eliminating the daily finger prick test. Although they’re no substitute for laboratory blood test procedures.

If the older person is struggling with insulin-dependent diabetes, then they need to administer daily insulin injections. Because of the challenges associated with ageing, self-administration using conventional needles or conventional insulin pens can be difficult.

Insulin pumps provide an excellent solution to this dilemma. They can be programmed to administer insulin automatically at meal times or be paired with an advanced CGM to inject insulin into the bloodstream if the glucose levels get too high, what’s known as an artificial pancreas.

Among the latest advancements in insulin administration are needle-free injections. This concept replaces the needle injection with a thin, rapid stream of insulin that penetrates the skin without pain or blood.

Not only is this an excellent solution for those who have needle phobia, but it can also be a much easier injection method for seniors who can find it difficult to load and inject conventional needles.

The needle-free InsuJet V5 injector takes the needle-free concept and injection simplicity to the next level.

The device has precise numerical scales to make it easier for anyone to aspirate the proper insulin dose. It also works by pressing the device against the preferred injection site.

Besides the needle-removal and unmatched simplicity, the InsuJet provides the following advantages:

• Compatibility: The injector is compatible with all U-100 insulins. It can even draw insulin from a smart insulin pen.

• Portability: The injector is small enough to be taken anywhere yet large enough to be easily seen (unlike syringes, which often get lost).

• Lack of infection: Since there’s no blood at the injection site, the infection risk chances are reduced to the minimum.

• Environmentally friendly: The injector spares you from having to buy needles, which reduces the impact of needle disposal on the environment.

• Cost-effectiveness: Each injector can be used up to 5,000 times, which is equivalent to 4-5 years of three injections a day.

The presence of risk factors for comorbidity in older diabetic patients can make managing diabetes complications and blood glucose levels a lot harder.

Thus, the UK government dedicates a portion of public spending on diabetes care and control. Programmes that provide the elderly and their families with the needed resources to manage their condition, through the NHS and otherwise, should help reign in any potential diabetes-related complications.

For elderly patients living with insulin-dependent diabetes, using continuous glucose monitors, insulin pumps, and needle-free injectors like the InsuJet can make insulin therapy a lot easier.