Ageing well with diabetes

Active health management

Active health management means doing all you can to be as fit and illness-free as possible, rather than seeing ill health as an inevitable side effect of growing older. Even if you have a medical condition, making efforts now to maintain and improve your health and fitness will help to maximise the control you have over your life later.

If you live with diabetes, active health management will likely already be in place in your day-to-day life. However, as you grow older, you may need to rethink how you manage the condition to ensure it lines up with the unique needs of living into your 70s and beyond.

Maybe you’ve had type 1 diabetes most of your life, or you’ve developed type 2 recently. You might be ‘well rounded’ or uber-lean and fit. Whatever your diabetes story, making sure you manage it appropriately for your age is one of the best steps you can take to ensure an enjoyable, secure, independent later life.

Everyone has individual needs, so it is important to discuss your diabetes management with your doctor and diabetes team and decide together what best suits you. Here are some factors to think about when you talk to them.

Staying active

Physical activity has enormous power to support body and brain health, and that fact doesn’t change as you age. Staying active – or becoming active, if you’ve let it slip – is one of the simplest things you can do to invest in your own comfortable and enjoyable future. And that especially applies to people with diabetes.

You may already know that good resistance exercise on most days of the week is ideal to help keep your muscles active and strong. However, you might be surprised to learn that muscle has an additional and important role in diabetes management.

This is because muscle that’s active uses much more blood glucose than usual, which helps to maintain healthy blood glucose levels. It also reduces the chances of diabetes developing in older age for people who haven’t previously had it.

So there are lots of good reasons to get active! You need to do both aerobic and resistance exercise, and many activities combine both. Aerobic exercise is anything that makes you puff a bit – like walking, running, cycling and swimming.

Resistance exercise means movements that involve your muscles working to push, pull or lift a weight. It can be things like lifting weights in a gym or doing push-ups, squats and lunges, but it can also be walking up stairs, doing aquarobic activity classes or digging in the garden. Some gyms offer supervised weight classes for older members at a reduced price, so check what’s available near you if this sounds like an interesting option.

You can read more about the benefits of a healthy muscle reserve in our article, Eating well in your 60s, 70s and beyond

Approaching weight loss

Managing your body weight is a particular cornerstone of diabetes management that may need to be revised as you grow older. Lots of people struggle to keep their weight down as the years pass, and you’ve probably heard ‘lose weight, lose weight!’ plenty of times, particularly in the media.

Now, there’s no doubt that weight loss is beneficial for young or middle-aged people who are overweight. But for older people, it can have adverse effects if it’s achieved by dieting only.

That’s because when you’re older, you are more likely to lose body muscle than fat if you diet. It’s only by pairing any dieting with a very good resistance exercise regime that you might avoid losing muscle.

Unfortunately, the difference between the benefits for younger and older people of dieting for weight loss is not widely understood, so you might receive lots of well-meaning and persistent advice to drop some kilos.

But the science is clear on this: weight loss without that very good resistance exercise is not recommended for anyone in their late 60s or beyond, especially if you have diabetes. A better approach is to get active, but don’t diet, to lose weight.

Avoiding hypoglycaemia

For young people with diabetes, management aims to keep blood glucose levels in a tight range to minimise the chances of complications over the years. This is vital, but such ‘tight control’ also increases the risk of blood glucose levels falling low enough to cause hypoglycaemia (a ‘hypo’) in some people with diabetes. Generally, only people with Type 1 diabetes and people with type 2 on certain types of diabetes medications are at risk of hypo. For both these groups the additional blood glucose used by active muscle, as mentioned above, also increases the risk of hypo following the activity. Self management is always encouraged in diabetes but before you make any changes yourself and especially if you are wanting to take up a new exercise regime, always consult your doctor/diabetes team to make a plan to keep you safe and support suit your individual needs.

During a hypo, people may experience shakiness, irritability, confusion, light-headedness and difficulty concentrating. For a younger person, the experience may be distressing but is not usually dangerous.

However, for people in their later years, it can be very dangerous indeed.

• A hypo greatly increases the chance of falling, which is arguably the most dangerous thing that can happen to an older person because it can often cause fractures or other serious injuries that are potentially catastrophic.

• In people who are already frail, a hypo can lead to a stroke or a heart attack.

• Frequent hypos may contribute to cognitive problems and will certainly reduce your confidence and ability to enjoy life.

Your chances of experiencing a hypo increase in later age for 3 main reasons:

1. Your ability to recognise the signs of falling blood glucose levels can fade, so a hypo can happen without the warnings you have been used to.

2. If you’ve had diabetes for some time, a hypo can happen at a higher blood glucose level than it once did. So while you might have been fine at 5 mmol/l in the past, that level might now trigger a hypo.

3. Reduced appetite and eating less than you need is common in older age but can have big consequences for people with diabetes. If you don’t eat enough food – especially carbohydrates – to keep blood glucose supplies up, then a hypo is more likely to happen.

Do you struggle with poor appetite? Read our article, The appetite deception: why some older people eat less than they need

Understanding blood glucose levels

While I would never suggest that having high levels of blood glucose in older age is a great idea, low levels could ultimately prevent you living the kind of later life you hoped for. That’s the reason why it’s worth reviewing your diabetes management with your doctor and diabetes team. Ask them whether a different focus with relaxed control is better for you now.

Relaxing control means allowing blood glucose levels to range a bit higher than previously to avoid the chance of a hypo. This could mean upper levels higher than you (and your doctor) would have been comfortable with in the past.

Many guidelines for older adults now aim for the blood glucose levels to not fall below 5 or 6 mmol/l – which means they will sometimes rise to 15 or 16 mmol/l and occasionally higher. These numbers would have elicited an audible gasp from your diabetes team in the past, but they may be a better approach for you from now on.

For some people, relaxed control has big advantages:

• It allows greater flexibility in what you eat.

• It helps keep your appetite up if it’s failing.

• It lets you eat as well as is necessary to help your body confront the challenges of ageing.

• Most importantly, it greatly reduces your chances of a hypo.

Remember, relaxing control of your blood glucose levels is not the ideal approach for everyone. Always discuss your own needs with your doctor and diabetes team.

Remember, poor health in old age is not inevitable, even if you are living with diabetes. There’s so much you can start doing now – no matter your age – that will make a difference to your health and fitness next week, next year, and even next decade.

Diabetes can be actively managed, not only by your doctor and diabetes team but also by you – at home, every day, in the food and activity choices you make. Being actively engaged in the management of your diabetes is a sound investment in the future you want to have.

Disclaimer: The information provided on this website is not a substitute for individual health advice from a doctor or dietitian.

By Ngaire Hobbins APD

Ngaire Hobbins is an Australian dietitian specialising in ageing and brain health. This article is based on her book, Brain Body Food, which presents in everyday language the science of eating well for healthy ageing. Brain Body Food is available through Ngaire’s website, or your favourite book retailer.