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Article by Ruben Castaneda via U.S. News
February 25th, 2019
LIVING WITH DIABETES presents a wide array of challenges that can vary depending on your age, gender, family situation and other factors, says Dr. Garth Graham, a practicing cardiologist and president of the Aetna Foundation in Hartford, Connecticut. "Living with diabetes means having to check your blood sugar, follow a regimented diet and live with a host of potential side effects and other conditions as a result of the illness," Graham says. "There is good news, however. Diabetes can be treated effectively in many cases by working closely with your doctor, paying attention to your dietary and exercise habits and complying with your medication regimen."
As of 2015, more than 30 million people in the U.S. – more than 9 percent of the country's population – were living with diabetes, according to the Centers for Disease Control and Prevention. In addition, more than 84 million were living with prediabetes, which can turn into Type 2 diabetes within five years if not treated properly. Type 2 diabetes, the most common type, is associated with obesity and excessive weight. Type 1 diabetes is an autoimmune condition in which the body attacks its own pancreatic cells that are responsible for producing insulin. This requires the individual to compensate by replacing the insulin by injection or pump for the rest of his or her life, says Dr. Jamie Wells, director of medicine at the American Council on Science and Health. Overall, diabetes is the seventh leading cause of death in the U.S., according to the CDC.
Complications of Diabetes
Complications associated with diabetes include:
Living With Diabetes as a Senior
While life with diabetes can be effectively managed, older individuals living with the disease may be at a greater risk for complications such as hearing loss, age-related mental impairment, dementia, kidney disease and heart disease, says Dr. Prakash Deedwania, a professor of medicine at the University of California—San Francisco. He's also a medical adviser to the American Heart Association and the American Diabetes Association's Know Diabetes by Heart initiative that provides resources for lowering cardiovascular risk for people living with Type 2 diabetes.
It's important to keep in mind that the longer an individual lives with diabetes, the higher his or her risk for cardiovascular disease and incidents like heart attacks and strokes. People over the age of 60 can lose up to 12 years of life from diabetes and cardiovascular-related events, according to the American Heart Association and the American Diabetes Association. Seniors, their loved ones and caregivers should talk with health care providers about appropriate treatment options and long-term care options to live healthfully with diabetes and how to decrease the risk of cardiovascular disease.
Adhering to a medication regimen can also be a challenge for seniors with diabetes, who may not have the sharpest memories because of their age, says Dr. Rocio Salas-Whalen, an endocrinologist and founder of NY Endocrinology in New York City. Doctors can help older people with diabetes by making their medication schedule easier to follow. "Simplifying a medication regimen will work best for elderly patients," she says. "Switching to one pill or shot a day will work better for compliance and memory than prescribing a three-times-a-day medication." An array of strategies can help older diabetes patients know when it’s time to take their medication, she says.
Some approaches for living with diabetes as a senior can include:
Aging Well With Diabetes
Aging well with diabetes is the same as aging well, Graham says. Staying physically active and consuming a healthy diet are key when it comes managing diabetes as you get older. There are many group exercise classes like water aerobics and gentle yoga for older adults that can help them age well with diabetes, Graham says. If you're an older person and have previously had a heart attack, cardiac rehab is a good way to learn healthy exercise habits in a monitored setting, he says. If you're unable to drive, physical therapists can often make house calls and perform physical therapy at home.
Living With Diabetes and an Eating Disorder
Some research suggests that eating disorders are probably more common among women with diabetes than women who do not have diabetes, Graham says. Bulimia is the most common eating disorder in women with Type 1 diabetes. Among women with Type 2 diabetes, binge eating is more common. "Eating disorders can have a devastating impact, but there is good news," Graham says. Many people find that interventions like therapy – whether it be individual or in a group setting – medications and other tools help them recover from an eating disorder and regain positive body image.
Living With Diabetes as a Women
Women with diabetes face an array of challenges, says Diana Isaacs, a clinical pharmacist and certified diabetes educator at the Cleveland Clinic. For example, there's a lot of pressure in society for women to lose weight or be thin. This can lead to a vicious cycle of dieting, losing and regaining weight, she says. Women with Type 2 diabetes who are overweight often face the stigma that their excessive pounds caused the disease, Isaacs says. "In reality, weight is only one of many factors and even people who are not overweight may develop Type 2 diabetes," Isaacs says. Restrictive diets can lead to binge eating and other eating disorders. An additional risk for women taking insulin for Type 1 or Type 2 diabetes is a condition called "diabulimia." This refers to skipping insulin doses in hopes of losing weight, Isaacs says. Unfortunately, this practice leads to dangerous complications including diabetic ketoacidosis and other long-term health problems including damage to the eyes and kidneys. It can also lead to pain in the hands and feet, a condition known as neuropathy. Women with diabetes and diabulimia or other forms of disordered eating should consider seeking help from a mental health professional and seeing a registered dietitian who specializes in the condition, Isaacs says.
There are other challenges women with diabetes will face, at different stages of their lives, she says. For example, menstruation can often lead to higher blood sugar readings as a result of increases in hormones during that time of the month. Pregnancy can be a challenging time because the glucose targets for an expectant mother are much lower because of potential risks for the unborn baby. "Meeting these strict targets can be very stressful for women," she says. Similarly, breastfeeding also presents challenges where women are more likely to experience low blood sugar, or hypoglycemia, and may need to cut back on their diabetes medications. "It's so important to work with your health care team, including a diabetes educator, to determine the best meal plan, exercise routine and medication adjustments to meet the targets for menstruation, pregnancy, breastfeeding and other life events," Isaacs says.
Living With Diabetes as a Man
Men experience many of the same complications of diabetes as women, such as fatigue, neuropathy and eye problems, Graham says. Men do, however, face some issues that are uniquely linked to them, including low testosterone and erectile dysfunction. Having Type 2 diabetes doubles your risk for having low testosterone. This drop in the hormone can cause low energy, muscle loss, depression and sexual problems, including low libido and erectile dysfunction, or ED. Your doctor can run a simple test to check your testosterone levels. Men with diabetes are three times more likely to experience ED than men without diabetes. This happens when high blood sugar damages small blood vessels or nerves, which affects a man's ability to get an erection. ED can cause damage to the nerves that control your bladder; this can lead to an overactive bladder and urinary tract infections.
In many cases, these health issues can be treated. The first step is to have an open conversation with your doctor. Start the conversation by saying you have some issues you would like to have addressed; if you are not comfortable speaking about these issues you can always send an email prior to your visit to prepare for the appointment. Men are more likely to have urological and sexual function problems if their blood sugar level is not under control.
Traveling With Diabetes
In the last 20 years, the number of adults diagnosed with diabetes has nearly tripled, Deedwania says. For people living with diabetes, planning and preparation are key, especially when it comes to travel. No matter the destination, there are several factors to take into consideration, such as location and proximity to the nearest hospital in case of an emergency, packing additional medical supplies and insulin, bringing appropriate medical identification and making smart eating choices with a regimen low in sugar, fat and cholesterol. "Working with a health care professional in advance of a trip can also help to ensure your vacation is a success," he says.
Living With Diabetic Foot Pain
Many individuals with diabetes suffer from foot problems as a result of nerve damage or diabetic neuropathy, which can lead to related issues, says Dr. Steven Neufeld, a foot and ankle surgeon at the Centers for Advanced Orthopaedics, based in Falls Church, Virginia. "If the nerves aren't working properly as a result of diabetes, diabetic patients may experience tingling, burning or pain in the foot, which can be treated with nerve medication to minimize the discomfort," Neufeld says. "In other cases, an individual might lose feeling in their foot altogether. This can potentially cause problems stemming from unrecognized injuries – for example, if a diabetic patient gets a cut on their foot or has an ingrown toe nail, the normal signs of pain are not triggered and could lead to an infection."
To prevent infection, necessary precautions should be taken on a daily basis, Neufeld says. Diabetic patients should check the bottoms of their feet every day. If they are having trouble, they should ask a partner or friend to help, or utilize a mirror. It's also beneficial to see an orthopaedic foot and ankle surgeon on a regular basis, who can trim nails, check for infection and make sure shoes fit properly. Routine visits, as well as specialized shoes and inserts, are often covered by Medicare, because of the importance of routine foot care in diabetics. Neufeld recommends that diabetic patients wear closed-toe shoes and socks that don't have seams, which can cause pressure on the skin and, potentially, on an unnoticed wound in the skin.
Besides nerve damage, diabetics can also develop problems resulting from poor blood flow, Neufeld says. If these patients do sustain a cut or infection in the foot, it may not receive the blood it needs to heal properly, which can lead to serious infection. In extreme cases, infection can lead to required amputation of the foot or leg. These issues can be avoided by proactively taking proper care of the body – eating well, keeping weight down, getting exercise and scheduling routine doctor's visits, he says.
Living With Financial Pressures Caused by Diabetes
The cost of managing diabetes has become a significant burden to the average U.S. resident, says Alison Wistner, the chief executive officer of Upwell Health, a provider of health care services, products and support that makes pharmacy the central point of care for people with chronic conditions. Upwell Health is based in Salt Lake City. For people with Type 1 diabetes, the annual cost of insulin nearly doubled between 2012 and 2016, according to an analysis by the Health Care Cost Institute. Those costs rose from an average annual price of $2,864 per patient in 2012 to $5,705 in 2016, according to the institute. Separately, an Upwell True Cost of Diabetes Report released in 2018 shows that 45 percent of people with diabetes have forgone care at some point because they couldn't afford it, she notes.
"Our report also found that one in three people spent $100-$500 of their own money for diabetes doctor care in the past year, and that an additional 16 percent paid a staggering $1,000-$5,000 out of pocket in the past year to treat diabetes complications," Wistner says. From a cost perspective, patients should utilize tools and resources that help them transparently compare drug prices and lock down the prescriptions that fit their personal budget, she says. Some organizations, like Upwell, work directly with pharmacies to generate personalized medication plans at the most affordable prices, helping patients save the most money possible. "In addition, ask about low-cost medical care in your community, patient assistance programs for expensive medicine and other ways to stretch your budget."
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