Brittle Diabetes Info for the Elderly
Brittle diabetes, as we now know it, can be troublesome not only for the patients but to the family and health care team. While this condition most often occurs in the 15-30 age group, there have been reports of this afflicting the elderly.
This prompted Drs. Susan Benbow of University Clinical Department of Medicine in Liverpool and Geoffrey Gill along with Angela Walsh of Diabetes Center in Liverpool to study the characteristics and cause of brittle diabetes in the elderly. How did they do this?
They sent out questionnaires to all UK hospital diabetic clinics for adults. They were therefore able to get reports for 55 patients who passed the criteria for brittle diabetes in the elderly. What are these criteria? They have to be 60 years old or over, on insulin treatment and have had their lives disrupted by glycemic instability with long or often hospitalization.
The calculation of the mean age resulted in 74 years old with 71% of the cases as female. The researchers categorized the brittle diabetes in the elderly into three types:
- mixed instability in 44%
- recurrent ketoacidosis in 29%
- recurrent hypoglycemia in 15%
If you're wondering why the above percentages didn't add up to 100%, it's because they had a few cases in which the information was not enough. In two-thirds (66%) of the cases, they found numerous causes for this diabetes in the elderly,
What did they find as the single cause of this condition? Well, they found for the 14% that the single cause included medical disease. They did not specify the medical disease although another study reported that their cases involved other chronic diseases. The other single cause is unawareness of hypoglycemic episode in only 6% of the cases.
They also found that problems regarding memory and behavior were uncommon. There were only four cases showing patients deliberately manipulated therapy. It is also good to point out here that 84% of these cases of brittle diabetes in the elderly were living alone.
Among the four cases of therapy manipulation, the two with recurrent ketoacidosis were judged as seeking attention by leaving out insulin. One had marital troubles and possibly depression. The suspicion was that she would gain personally from her glycemic instability.
The fourth case was considered depressed and calculating. All her hypoglycemic episodes happened in public. But it should be pointed out here that in all these cases there were other factors that may have contributed to the instability, most particularly chronic non-diabetic medical condition.
The main sign of this condition in younger patients is recurrent ketoacidosis but this study seems to indicate that in the elderly, the patterns and causes are different. Now with the older group using more and more insulin therapy, we are bound to see more of the same cases.
The diabetes care team found numerous causes of the condition as indicated above. But more importantly, the survey results show that brittle diabetes in the elderly exists and is a problem that cannot be ignored. It is not only troublesome for the family but for the care team as well.
For the hospital admission for diabetics, the elderly gives different reasons. The most common is mixed brittleness. Compare this with studies for the younger group with ketoacidosis as the most common reason. As for the female/male ratio, there are more females among the elderly group which is not a surprise. So this ratio is not statistically important.
Diabetes in the Elderly: What's the Goal?
There is a difference between the older and the younger group, medication-wise. Of course, the reason is clear. As we get older, the kidney starts to decline and so are the other parts of the body. And so some diabetic pills are not to be prescribed for older patients who have kidney problems. The same is true for those with heart condition. Even for the blood glucose level, physicians sometimes want older patients have different target from the younger ones.
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End of Newsalert
There is not much published on unstable diabetes in the older population. In Birmingham, UK 25% of those with recurrent episodes were over 59 years old. Griffith and Yudkin found most have mixed brittleness. No clear cause for the instability was noted.
Then in 1981, Gale et al from Nottingham reported that 33% of diabetic patients admitted over a period of 7 years were over 50 years old. It is clear that brittle diabetes in the elderly is here to stay and prevention and management will need a multidisciplinary approach.
Quick tip: When the blood sugar level is well-controlled, the risk for major complications like amputation heart attacks and kidney illness is lower. So did a new study of older patients who have diabetes find.
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