Managing T1DM in the elderly compares to managing T1DM in children in the same way that managing traffic in Times Square, New York, compares to managing traffic in Broken Bow, Nebraska. There's a lot more going on in the elderly.
The differences between the elderly and younger people with T1DM play a major role in complicating diabetes management. The following points apply to the elderly:
1 They may be forgetful and fail to take medications, check blood glucose levels, exercise, or eat properly. (See the next section for information on determining whether you or your loved one can take care of his T1DM.)
i They may take three to seven other drugs in addition to insulin. Some of the drugs may interact with the insulin, and some may just cause confusion in timing of doses.
i They often have decreased sensations of taste and smell, so they aren't interested in food.
1 They often have poor teeth and a dry mouth. The poor teeth may make diabetic control more difficult.
1 They have reduced kidney function.
i They often live alone and have no one to help them.
1 They may not recognize hypoglycemia. (If you don't recognize it either, see Chapter 4.)
1 They may be unable to afford their medications and may have to spend their limited resources on an inexpensive diet that's rich in fat rather than more low-glycemic carbohydrate and protein. (I discuss resources for patients on fixed incomes later in this chapter.)
1 They may be physically unable to give themselves insulin shots with a syringe and needle.
1 They're less physically fit and less physically active than younger people.
1 They have reduced muscle mass and increased fat mass.
1 They're more sensitive to drugs due to slower metabolism.
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