November is National Diabetes Month and it’s a time when communities across the nation bring attention to one of America’s most common chronic health conditions. Diabetes is one of the most serious issues impacting our nation’s older adult population. According to the American Diabetes Association (ADA), about one in four people over the age of 65 have diabetes in America. Having diabetes at an older age makes people more susceptible to complications such as vision problems and hearing loss. That’s why it’s important that facilities take a multi-prong approach to help residents keep their diabetes under control.

Insulin helps glucose get into the cells, where it can be used to make energy. Diabetics do not make enough insulin, may not use insulin in the right way or both. That can cause too much glucose in the blood. Over time, this can cause serious health problems, such as heart disease, vision loss, and kidney disease.

There are two main kinds of diabetes- Type 1 and Type 2. Type 1 diabetes means the body makes too little or no insulin. Although older adults can develop this type of diabetes, it occurs most often in children and young adults. According to the Centers for Disease Control and Prevention (CDC), Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake) this stops the body from making insulin. About 5 percent of the people who have diabetes have Type 1. People with Type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes is the most common kind of diabetes among the older population. In Type 2 diabetes, the body makes insulin but does not use it correctly. As a result, the body cannot keep blood sugar at normal levels on its own. The chance of getting Type 2 diabetes is higher if a person is 45 or older, overweight, inactive or has a family history of diabetes. Also, women who had gestational diabetes are more likely to develop Type 2 diabetes later in life. Age-related insulin resistance and decreased pancreas function are related to the onset of diabetes in older adults.

Common symptoms of diabetes include fatigue, extreme thirst or hunger, slow healing from cuts and bruises, frequent urination and blurred vision. However, in older people, these symptoms may not be readily recognized or reported because of age-related changes such as decreased sense of thirst or cognitive declines. Symptoms for older diabetics may also include dehydration, dry eyes, dry mouth, confusion and incontinence.

Careful diabetes management helps keep diabetics healthy and prevents complications. There are several medications that help to lower blood sugar in different ways. Many people with Type 2 diabetes will eventually need insulin due to the body decreasing the amount of insulin it produces over time. Regular monitoring of blood sugar is an important part of managing diabetes on a daily basis and controlling hyperglycemia or hypoglycemia. Along with monitoring, diabetes medication and possibly insulin, a Type 2 diabetic may also need to have their diet managed.

In its “Standards of Medical Care in Diabetes—2019,” ADA released recommendations for caring for older diabetics in the skilled nursing setting. Older adults living in long-term care facilities are susceptible to hypoglycemia, according to ADA. The organization stresses the importance of facilities providing careful assessment of diabetic residents and establishment of individualized glycemic goals, nutrition and appropriate treatment regimens for managing their conditions. Additionally, ADA recommends that facilities consider diabetes education for staff that covers diabetes detection, policies and procedures for diabetes prevention and management as well as timely notification of blood glucose management issues.