What's Your Diabetes IQ?

Diabetes can triple the risk for heart attack and stroke, and it's the leading cause of blindness, amputations, and kidney failure. But the disease can wreak havoc from head to toe—affecting everything from hearing and gum health to sexual and mental function and sleep.

There is no such thing as a special diabetes diet. For someone with diabetes, healthy eating is no different than a healthy diet for anyone else. That means a meal plan based on lean protein, whole grains, vegetables, and fruit. Such a diet is low in fat (particularly saturated and trans fats), salt, and simple sugars. So-called diabetic foods offer no special benefits. Your best bet would be to skip these costly commercial offerings and head for the produce aisle instead. The best way to incorporate more nutritious foods into a diet is by taking small steps.

The A1c test (you pronounce each letter and number separately), also referred to as the hemoglobin A1c or glycosylated hemoglobin test, gives information about average blood glucose levels over the previous six to eight weeks. It measures the amount of glucose, or sugar, that sticks to red blood cells' oxygen-carrying protein molecules, known as hemoglobin. This test gives an overview of how well an individual is keeping blood sugar in his target range on a regular basis. It's a handy way to look back over time to see the effects of treatment, such as medication, diet, or exercise changes. The American Diabetes Association recommends an A1c result of below 7 percent, while the American Association of Clinical Endocrinologists suggests a figure of 6.5 percent or lower. Discuss with a doctor the ideal target number based on individual health history.

Many older people with diabetes are asymptomatic—meaning they have no symptoms—and so they may remain undiagnosed until serious complications from the disease arise. Typical symptoms include unusual weight loss, thirst, hunger, fatigue, frequent urination or infection, tingling or numbness in the hands and feet, and vision problems. Older people with diabetes and their caregivers often don't recognize symptoms of the disease. For example, increased thirst is hard to detect in the elderly because they tend to lose their ability to recognize this sensation. Or a senior may just chalk up frequent urination, another warning sign, to advanced age. When a senior does notice signs of type 2 diabetes, those signs can be confusing in terms of what they indicate about blood sugar levels. For instance, a senior may feel tired, hungry, and shaky, all typical red flags for hypoglycemia (low blood sugar), but a test of his blood glucose may reveal that he's actually experiencing hyperglycemia (high blood sugar).

In the long term, keeping blood glucose under control—between 90 and 130 milligrams per deciliter (mg/dl) before a meal and under 180 mg/dl after a meal, according to the American Diabetes Association guidelines -- can help prevent or delay diabetes complications, such as nerve, eye, kidney, heart, and blood vessel damage. In the short term, maintaining glucose levels in a senior's target range can help her stave off problems such as hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar).

• Three to four glucose tablets

• One serving of glucose gel

• A half-cup (four ounces) of fruit juice

• One cup (eight ounces) of milk

• One to two teaspoons of sugar or honey

• Five to six hard candies
  

The typical profile for a person with type 2 diabetes looks like this: someone age 45 or older who's overweight and sedentary, with a family history of the disease. People who have high blood pressure (hypertension) or heart disease are at increased risk as well. Type 2 diabetes occurs more frequently in certain ethnic groups, including African Americans, Latin Americans, Asian and Pacific Islanders, and native Americans.

Despite a senior's best efforts (and yours) to make lifestyle changes to keep his diabetes under control, over time he may still need some extra help from prescription medications to stay in his target blood glucose range. For starters, increased insulin resistance, or the body's inability to respond to and use the insulin it produces, tends to be more of a problem as a person ages, even if he isn't particularly overweight or inactive. This isn't a sign of failure or something he (or you) should feel bad about. It's simply an unfortunate fact of this chronic, complex condition, which progresses over time. That said, it's still smart for a senior with diabetes to follow the advice of his health professionals to maintain overall well-being and keep complications at bay.