Treatment of Diabetes Complications and Associated Disorders

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Diabetes complications in elderly people are treated in the same ways as in younger individuals. Treating the lipid abnormalities (see Chapter 3) and blood pressure is equally beneficial in the elderly as in younger individuals. In fact, because the risk for heart attack and stroke is higher in the elderly, benefits may actually be greater than in the younger population. The blood pressure target is less than 140/80 if tolerated. ACE inhibitors and angiotensin receptor blockers (ARBs) can be used to lower blood pressure, but these medicines can raise the potassium and serum creati-nine levels. High potassium levels can be dangerous and affect the heart rhythm. Therefore, your doctor will ask you to get lab tests one week after you start taking these medicines to make sure that your potassium is in the safe range.

Often, elderly people are on many different medications because they are being treated for other medical problems as well. In these situations, you need to watch out for drug interactions between medications, because they will affect your well-being. For example, if you are taking glipizide for your diabetes, taking an antibiotic called ciprofloxacin can sometimes cause low glucose reactions.

Prednisone, a steroid that is given for bronchitis and rheumatological conditions such as acute gout, polymyalgia rheumatica, and other inflammatory conditions, can cause glucose levels to go high, and adjustments in your diabetes medications may be necessary.

If you are taking nitrate medicines for heart disease, you cannot use the phospho-diesterase inhibitors (sildenafil, vardenafil, or tadalafil) for erectile dysfunction.

So, when you get a new medicine prescription from your doctor, talk to your pharmacist and make sure that the new medicine will not interact with the medications you are already taking.

Summary

• Diabetes is more likely to occur as you age.

• The blood glucose targets are the same as in younger individuals except in frail individuals, when an HbA1c level of less than 8 percent is acceptable.

• The treatment options are the same as in younger individuals except that you need to take into account the changes related to aging (such as vision, dexterity, mobility, and memory) and other medical problems (such as heart and kidney failure).

• Diabetes self-management is important—work with your medical team (the nutritionist, diabetes educator, and primary care physician or endocrinologist) to design the treatment plan appropriate for you.

• If you or your family member with diabetes is living in a residential home, work with the medical team and caregivers at the home to make sure that everybody knows how the diabetes should be managed.

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