Blood Glucose

Elderly Patients: Need for Blood Sugar Control

January 11, 2017   /

Dietitians working in long-term care often struggle with patients who have elevated blood sugar. How high is too high for this population? Should you make an effort to normalize blood sugar in this population group?

Older adults who are functional, cognitively intact, and have significant life expectancy should receive diabetes treatment using goals adopted for younger adults. These goals are outlined at http://care.diabetesjournals.org/content/35/Supplement_1/S11.full. A1c is the preferred method of evaluating blood sugar. For normal healthy adults, <7.0 is a reasonable goal, indicating good blood sugar control. As patients near the end of their life or have other medical conditions, goals for blood sugar control become less clear.

According to the American Diabetes Association® in its Standards of Medical Care in Diabetes—2012, few long-term studies in older adults demonstrate a benefit to intensive glycemic control. However, patients with poorly controlled diabetes may experience some of the acute complications of diabetes, including dehydration, poor wound healing, and hyperosmolar comas. Pressure ulcers, diabetic ulcers, and stasis ulcers may heal more slowly when blood sugar is uncontrolled, so patients with these conditions may benefit by controlling their blood sugar.

Glycemic goals for other older adults sometimes are relaxed using individual criteria, but it is important to avoid hypoglycemia leading to symptoms or risk of acute hyperglycemia complications whenever possible. According to the American Medical Directors Association, for elderly adults, an A1c of <8.0 may seem more appropriate than the 7.0 guideline set for other adults.

Complicating the issue of glycemic control is the fact that blood sugar is affected by a number of different factors, including:

  • Acute infections, such as urinary tract infections or pneumonia
  • Obesity
  • Metabolic syndrome
  • Diseases of the pancreas
  • Endocrine diseases, such as Cushing’s syndrome
  • Genetic defects of beta-cell function or insulin action
  • Other genetic conditions, such as Down syndrome

Medications
Many medications can affect blood sugar, including many antipsychotic medicines, thiazide diuretics, estrogens, and Megace®. In many frail elderly patients, it is not realistic to manage medical conditions or change medications in an attempt to reduce blood sugar levels.

Implications for dietetics practitioners
Evaluate each long-term care patient with elevated blood sugars individually to determine if blood sugar control is necessary or realistic. Blood sugar control is important for long-term care patients who have a significant life expectancy and the frail elderly who are experiencing dehydration or poor wound healing.

 

References and recommended readings

American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care [serial online]. 2012;35(suppl 1):S11-S63. http://care.diabetesjournals.org/content/35/Supplement_1/S11.full. Accessed July 29, 2012.

American Medical Directors Association. Diabetes Management in the Long-Term Care Setting: Clinical Practice Guidelines. Columbia, MD: American Medical Directors Association; 2008.