Senior Home-Healthcare Tips
By Anita Kamiel, RN, MPS
Insulin is needed for the body to convert the sugar from food to energy for cell functioning. In typeÂ 2 diabetes, cells become insulin-resistant, thereby hindering the ability of the pancreas to produce enough insulin to regulate the blood sugar. Medication is then needed to supplement it in the body.
TypeÂ 2 diabetes is all too common in the elderly. Possibly because it has become so common and sufferers appear to be functioning well, people tend to overlook the substantial complications that could result from the disease.
The increased risks associated with typeÂ 2 diabetes include hypertension, heart attack, stroke, hypoglycemia, retinopathy, and kidney disease. Diabetes has also been linked to a higher risk for dementia, especially if the diabetes is poorly controlled.
Typically, medication is used to control the level of blood insulin, which is determined by finger pricks of blood for glucose testing throughout the day to monitor the amount needed. Medication is usually oral or injected. Control has always been tricky, since it is a reactive measure rather than the real-time release provided by a normally functioning pancreas.
Overtreatment of hyperglycemia (high blood sugar) is common and can easily plunge someone into hypoglycemia (low blood sugar), depriving the brain of oxygen and leading to collapse, loss of consciousness, or even death. In fact, as reported in the Journal of the American Medical Association (www.ncbi.nlm.nih.gov/pubmed/24322626), insulin-related drugs are the second most common class of drugs leading to those 65 and over visiting the emergency room. Researchers also state that hypoglycemia in older patients is more dangerous in the short term than hyperglycemia.
Traditional delivery methods have been injectable insulin and oral medication. But there are new delivery methods that seek to address the uneven distribution of dosing that can be associated with that standard of care and the risks of hypoglycemia. Other benefits of these devices include improved convenience in addition to reducing the burden of tracking or the inadvertent omission of doses.
Insulin pumps, more often associated with typeÂ 1 diabetes, have become much more common for people with typeÂ 2 diabetes, especially for those who have not responded well to the standard of care. These are portable devices that are attached to the body through a catheter under the skin. They deliver a constant flow of insulin rather than a larger, “one-shot” dose, thereby reducing the hyper- and hypoglycemia so common to sufferers.
A smart insulin patch is being developed that senses the body’s glucose levels through nanotechnology and releases insulin via a patch. The patch is attached to the skin and has microneedles loaded with enzymes that trigger release of insulin into the bloodstream as needed. It is still in the testing stage but has received substantial funding from the American Diabetes Association.
The FDA also approved the insulin drug Afrezza, which is inhaled rather than injected. It has limited uses and there have been issues bringing it to market, but could be a good, convenient option for some who are able to control their sugar by taking a puff out of an inhaler at the beginning of a meal. However, due to concern regarding its effects on the lungs, smokers or people with asthma or lung disease or are advised not to use it.
There is increasing evidence that environmental stress plays a role in typeÂ 2 diabetes. When the body is under stress, cortisol is released to give the person energy to flee. However, according to research funded by ADA, when we are under constant stress but don’t combine it with physical activity (i.e., we don’t actually run), we have chronic elevated cortisol levels. These elevated levels result in insulin resistance, making the pancreas work overtime to produce enough insulin. These insulin-producing beta cells can wear out prematurely, leading to typeÂ 2 diabetes.
Lifestyle changes are a definite prescription for those with typeÂ 2 diabetes–changes that would benefit the population as a whole. Finding ways to reduce the stress in our daily lives, whether through distractions such as social clubs and hobbies or through “news fasts,” meditation, or yoga, should be high on the priority list for 2017. Of course, there are the obvious steps of losing weight and adding exercise to the mix.
Hope For The Future
Exciting research is on the horizon with the goal of creating an artificial pancreas that consistently monitors and adjusts insulin levels through technology. It can even be controlled from an iPhone. There is also groundbreaking research from Israel with respect to transplanting insulin-producing cells and glucose-sensing enzymes that could have implications for typeÂ 2 diabetes.
In any case, the combination of the statistics and potential complications from the disease make a strong case for finding a cure a national priority.
Anita Kamiel, R.N., M.P.S., is the founder and owner of David York Home Healthcare Agency and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.