The Relationship between Aging and Diabetes

The incidence of diabetes is rapidly rising around the world. In 2017, nearly 430 million people were diagnosed with diabetes – 80% of whom comes from low to middle-income countries – and it is projected to grow to about 629 million by the year 2045. This rapid increase in the number of people with diabetes poses a threat to public health. This is why it’s important for all of us to know the normal blood sugar by age, and how to keep it at a normal level.

There are three major types of diabetes:

• Type 1, which is an autoimmune disease
• Type 2, which is a lifestyle- and age-related condition
• Gestational diabetes, which is related to and diagnosed during pregnancy.

The criteria for the diagnosis of Type 1 and Type 2 diabetes mellitus are as follows: 

• Random blood glucose of more than 200mg/dl, together with clinical symptoms such as an increase in appetite, increased thirst, and increase in urine output.
• Fasting blood glucose of more than 126mg/dl
• 2-h plasma glucose ≥200 mg/dl following a 75-g oral glucose challenge in adults.
• HbA1c of less than or equal to 6.5%

Normal Blood Sugar by Age: Symptoms of Diabetes in the Elderly

In the elderly, diabetes usually manifests with vague and non-specific symptoms, such as an increase in urination, increased thirst, and signs of dehydration like dry mouth.

They may also present with confusion, lethargy, weight loss, fatigue, and weakness. Research shows that about 60% of elderly patients with Type 2 diabetes suffer from other comorbid diseases, the most common of which are hypertension, hearing and visual impairment, urinary incontinence, cognitive impairment, and depression.

How Aging Increases the Risk of Diabetes

As mentioned, Type 2 diabetes is generally age-related, which means that older people are more at risk of acquiring Type 2 diabetes. The prevalence of Type 2 diabetes among the elderly then raises the question, “How does aging put me at risk of acquiring diabetes?”

Skeletal Muscle Dysfunction

The increased incidence of Type 2 diabetes mellitus among the elderly is closely linked to skeletal muscle dysfunction. Skeletal muscles play an important role in the body’s glucose metabolism and have an effect on how the body responds to insulin – a hormone that allows the body to absorb and utilize glucose.

In healthy people, skeletal muscles are highly sensitive to insulin. They can increase glucose uptake with sudden increases in blood glucose levels to keep the blood glucose levels within normal.

As people age, skeletal muscles undergo wear-and-tear and acquire more damage. Skeletal muscles become increasingly resistant to insulin, and elderly people progressively lose the ability to keep their glucose levels within the normal range, eventually leading to diabetes.

Sedentary Lifestyle

Another factor that directly affects glucose metabolism is having a sedentary lifestyle. Generally, older people are less active than their young counterparts.

Studies have shown that having a sedentary lifestyle, particularly sitting or lying down over long periods of time, can lead to changes in the body’s metabolism. This includes a decline in insulin sensitivity, which then results in increased blood glucose levels and eventually, Type 2 diabetes. It is therefore recommended that an active lifestyle, in concurrence with dietary changes, must be promoted among the elderly.

Beta-cell Destruction

An important aspect in the development of Type 2 diabetes among the elderly is associated with beta-cell destruction. Insulin is synthesized in and secreted by beta cells located in the pancreas. In normal, healthy adults, the beta cells secrete insulin in direct proportion to the glucose levels in the bloodstream. That is, when glucose levels rise above the normal range, the body will send a signal to the beta cells to produce more insulin to help absorb glucose.

However, with age, beta-cell function declines, and in turn, the amount of insulin released in the body decreases. This leads to dysregulated glucose levels in the bloodstream and eventually, diabetes. 

Managing Diabetes in the Elderly

The management of diabetes among the elderly involves a multidisciplinary approach. In general, management begins with lifestyle modifications, applying changes in diet and physical activity that would help combat insulin resistance. Patient education and psychosocial support are also central to disease management. As the disease progresses, pharmacologic therapy may be instituted.

As recommended by the American Diabetes Association, treatment goals for diabetes should be individualized for each patient. Generally, the following are the treatment goals for adults with diabetes:

• HbA1c of less than 7.0%
• Preprandial capillary plasma glucose of 80 to 130 mg/dL
• Postprandial capillary plasma glucose of less than 180mg/dL

Key Takeaways

Diabetes is a multifactorial disorder that involves genetic, environmental, biological, and age-related factors. Elderly patients have a higher risk of acquiring diabetes, and the sooner diabetes is diagnosed, the higher the chances of placing it under control.