How Type 2 Diabetes Affects Nutrition for People Age 65 and Older - Essay Example

Type II Diabetes and Nutrition in the Elderly Introduction Diabetes is a dreaded disease which is being encountered with alarming regularity due to sedentary lifestyle of the modern day man. Excessive dependence on automation and machines has brought forth a number of newer ailments which were unheard of in the history of mankind. Diabetes though having some genetic component can occur by diverse etiological mechanisms. The incidence of diabetes has increased manifold during the past few decades. With better healthcare and increased longevity, such ailments have assumed alarming proportions amongst the growing number of aged people in society. Unlike Type I diabetes which can strike at any age due to either an inherent/genetic or induced/secondary defect of insulin production from the pancreas, Type II diabetes is usually late in onset as it occurs in only 3-5% of the American population below 50 years of age (www.answers.com). The incidence increases to 10-15% in people above 50 years but accounts for 90% of the diabetes cases in the US. Nutrition in the elderly plays an important role on their physiological status as well as susceptibility to certain diseases. Geriatric requirements for carbohydrates, protein, fat, vitamins and minerals vary with the hormonal changes in their body as well as the stress factors and coexisting chronic diseases. Coupled with psychological tensions like loneliness and depression, physical inactivity predisposes the elderly to a plethora of conditions due to the dwindling immunity and resistance. Regular medical diagnosis and appropriate nutritional and therapeutic interventions are therefore absolutely essential in the elderly. An early diagnosis and religious compliance to the therapist’s interventions are the keys to success in therapy. Etiology Basically diabetes is caused either by the lack of the hormone Insulin, or the disruption of the physiological mechanisms involving its functional utilization. Insulin is necessary for the proper mobilization and utilization of glucose inside the cells where it is the primary energy source. Type I diabetes also known as juvenile diabetes is usually due to the former reason as the Insulin producing cells in the pancreas are deficient or get destroyed leading to the physiological cessation of production of insulin which has to be provided from exogenous sources in such patients. In Type II diabetes, however the reasons are entirely different as insulin production is usually normal in such persons. It is the utilization of insulin that is affected in persons suffering from Type 2 Diabetes. It usually occurs in people who are overweight and don’t exercise optimally. The excess fat content in the body prevents the binding of insulin to cells leading to improper utilization of glucose and subsequent hyperglycemia. This triggers further secretion of insulin whose blood levels rise beyond acceptable limits. Excess glucose in the bloodstream is compensated by drawing fluid from the cells in order to dilute it which causes dehydration of the cells which triggers more thirst and hunger. There is increase in urine output and subsequent physiological stress on the body. Type II diabetes is also known as age-onset or adult-onset diabetes (www.answers.com). However with the increase in the consumption of junk food and lack of exercise amongst children it is occurring with increasing intensity in young children too. Family history of the disease and the prevalence in certain ethnic groups suggest a genetic predisposition to this type of diabetic disorder. Type II diabetes can usually be controlled just with proper exercise and diet control but may require the use of insulin in certain exceptional cases. Pathophysiology Type II diabetes develops when two factors coexist, i.e. peripheral insulin resistance combined with varying degree of defects in the secretion of insulin (Votey, 2008). Almost all overweight persons suffering from this malady invariably satisfy the above two criteria. In this type of diabetes, the glycoprotein receptor sites for insulin on the outer surface of the membrane of target cells are unresponsive to insulin and glucose is not taken up into the cells. Blood glucose levels remain high leading to hyperglycemia and, if untreated, eventually lead to glucose toxicity and death. The major changes in type II diabetes are the development of erratic blood glucose varying from hypo to hyperglycemia, increased predisposition for infections, peripheral nephropathy/retinopathy sometimes leading to blurred vision as well as blindness (Votey, 2008). It can also precipitate cardiovascular disorders. As some degree of insulin secretion is there in such patients, the therapeutic interventions have to be designed accordingly after individual evaluation. Special Problems in the Elderly Patient Aging produces many functional changes inside the body that make it more susceptible to the occurrence of endogenous disease as well as increased susceptibility to infections. The major functional deteriorations in the aged persons are decrease in immunity, basal metabolism, lowered oxygen consumption, decreased adaptability to altering conditions, decreased digestive ability and a general slowdown of reflexes and neural responses (Munro, 1984). These functional disorders are accompanied by physical changes such as a ‘reduced muscle mass, increased fat content, hardening of soft tissues, atherosclerosis, osteoporosis and decreased extracellular fluid’ (Munro, 1984). Accordingly diabetes management in the elderly is difficult as diet control and exercise can be subject to certain limitations in particularly frail and weak individuals. Moreover compliance for drug therapy in the elderly can be a problem without close supervision and appropriate nursing supervision. As digestive processes are usually slow in elderly individuals it is difficult to diagnose and maintain adequate blood glucose levels with continuous monitoring. Concurrent cognitive disorders and neurological impairment can prove a hurdle in the maintenance of an appropriate therapeutic regimen as well as practicing diet control (www.diabetes.co.uk). In patients aged 65 and over there are many instances of type II diabetes going undiagnosed altogether as the prevalence of undiagnosed cases is 6.9% in the US elderly population (Selvin E. et al, 2006). In such patients the presence or severity of diabetes associated disorders varied within populations in which the onset of diabetes was at the middle-age stage as compared to those who were diagnosed at relatively later stages (elderly onset of diabetes) (Selvin E. et al, 2006). It was observed by the authors of this study that the overall therapeutic glycemic control measures were much poorer in the ‘elderly-onset’ patients. The housing pattern of the elderly also has some bearing on the diabetes care as those living in their own homes were found to have a better care pattern as compared to those living in ‘residential care’ (Tong P., 1994). Elderly patients living in public residential homes or old age homes therefore require a better care pattern and appropriate nursing care under competent medical supervision as diabetes is a disease which needs constant monitoring and supervision. In case insulin is required as an adjunct to therapy in the elderly over 65 years of age, it poses an additional risk of the occurrence of hypoglycemic shock in such individuals which on most occasions can be fatal due to poor generalized health of the elderly patient. Linkage of Diabetes with other Diseases in the Elderly Concurrent diseases in the elderly can easily be extrapolated to diabetes and vice versa as many interactive physiological processes go on simultaneously in the body. Anemia, malignancy, osteoporosis and Alzheimer’s disease put increasing amounts of stress on the body by disease process itself and additionally by the iatrogenic side effects of therapeutic drugs used in such patients. There is evidence to suggest that geriatric patients suffering from Alzheimer’s disease have the tendency of being susceptible to type II diabetes (Janson et al, 2004). In a study conducted by the authors on such patients it was found that there could be a shared disposition for the development of amyloidal proteins in the islet cells in pancreas and in the brain cells of such patients indicating a common pathophysiological link between the two diseases. Drugs used for treatment of various diseases as well the vitamins and nutritional supplements used in the elderly have their own side effects like nausea, vomiting, diarrhea or constipation which can have far reaching consequences on the nutritional status of the elderly which can further complicate measures taken to tackle diabetes. In order to tackle type II diabetes in the elderly as well as other patients, the major approach is diet restriction coupled with exercise with least reliance on pharmacological approaches as the latter can have more adverse effects in the already physiologically compromised elderly patients. Nutritional approaches in the treatment of type II diabetes usually rely on dietary fat reduction (Accurso et al, 2008). The authors suggest that the approach has had limited success as physicians have a tendency to fall back on pharmacological interventions rather than diet control alone. Restriction on dietary carbohydrate rather than fat has been suggested by the authors as an alternative and superior therapeutic strategy. According to them carbohydrate restrictive diets rather than fat restrictive ones have a superior glycemic control and also reduce insulin fluctuations which are the target therapeutic strategy in type II diabetes. Substitution of carbohydrate by moderate amounts of fat also reduces the risk of associated cardiovascular disorders. This strategy also eliminates the dependence on anti diabetic drugs and the weight control regimen is comparable to that with the fat restrictive strategy. This therapeutic strategy has also been found to be superior in the context that there is no targeted weight loss regimen which in turn becomes beneficial as too much loss of weight can complicate the situation in such patients. Conclusion In patients over the age of 65, diabetes has a better prognosis only if it is uncomplicated with concomitant diseases and the onset has been relatively late. More reliance on diet restriction and assisted compliance with a sensible therapeutic strategy of mild exercise combined with scientifically planned food intake is a better strategy rather than depending on pharmacological control of the condition. The presence of ready assistance at critical times and a better social environment for the elderly also play a role in reducing the deleterious effects of the disease. References: Accurso Anthony, Bernstein Richard K , Dahlqvist Annika , Draznin Boris , Feinman Richard D , Fine Eugene J , Gleed Amy , Jacobs David B , Larson Gabriel , Lustig Robert H , Manninen Anssi H , McFarlane Samy I , Morrison Katharine , Nielsen Jørgen Vesti , Ravnskov Uffe , Roth Karl S , Silvestre Ricardo , Sowers James R , Sundberg Ralf , Volek Jeff S , Westman Eric C , Wood Richard J , Wortman Jay and Vernon Mary C , 2008, Review Article: Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal, Available online at: http://www.nutritionandmetabolism.com/content/5/1/9 Diabetes and the elderly, Online article available at: http://www.diabetes.co.uk/diabetes-and-the-elderly.html Diabetes Mellitus,Pgs.1-53,Article available at: http://www.answers.com/topic/diabetes-mellitus Janson Juliette, Laedtke Thomas, Parisi Joseph E., O’Brien Peter, Petersen Ronald C. and Butler Peter C. , 2004, Increased Risk of Type 2 Diabetes in Alzheimer Disease, DIABETES, VOL. 53, Pgs 474-481 Munro H.N.,1984, Nutrition and the elderly: a general overview. J. Am. Coll. Nutr.3: 341–350 Selvin Elizabeth, Coresh Josef and Brabcati Frederick L, 2006, The Burden and Treatment of Diabetes in Elderly Individuals in the U.S., Diabetes Care 29:2415- 2419 Tong P, Baillie S.P. & Roberts S.H.,1994, Diabetes care in the frail elderly, Practical Diabetes International, Volume 11, Issue 4 , Pages163 – 164 Votey Scott R., 2008, Diabetes Mellitus, Type 2 - A Review,Pgs 1-24, Online article available at: http://www.emedicine.com/emerg/topic134.htm Read More