Las Vegas Sun

March 29, 2024

Health Care Quarterly:

Don’t let a diagnosis of diabetes overwhelm you

According to the American Diabetes Association, 25.9 percent of seniors age 65 and over have Type II diabetes. Diabetes is a diagnosis that can be treated and managed as part of the daily routine. Diabetes-related complications can include kidney failure, blindness, amputation, stroke and heart disease. When presented with such possible outcomes, it’s very easy to be overwhelmed by the diagnosis. But consequences can be significantly reduced with knowledge, lifestyle change and (usually) medications. Let’s look at some of the barriers to care that seniors may encounter and how we can overcome them.

First, we live in Las Vegas. With countless buffets, free drinks and extensive marketing campaigns targeting seniors, it is very easy to deviate from any type of healthy diet. Knowing the obstacles and having a plan can help. For example, there are almost always healthier options at the buffet, and not just the “no sugar added” desserts. Avoiding the pasta section, focusing on the salad and protein choices and walking a couple of laps around the property afterward are options.

Another concern for seniors is information overload. Radio and TV commercials, magazine and newspaper ads tell of the “perfect” treatment for diabetes. Sometimes too much information is detrimental.

If you hear, see or read about a medication or treatment option, write it down and ask your provider. Saying “I think it started with a T” is not enough information. If it is an herbal (or other) supplement recommended by anyone from Dr. Oz to your neighbor, write it down and discuss it with your provider before starting to use it.

Now let’s talk a little bit about insulin. The pancreas produces insulin. We absolutely need insulin to live. When a patient is first diagnosed with diabetes, it usually means that about 50 percent of their pancreatic function is gone. As diabetes progresses (which it does much more quickly with a high-carbohydrate diet and limited activity), pancreatic function declines more quickly.

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A high percentage of Type II diabetics end up on insulin. Yet, for a lot of people, the starting of insulin is delayed due to fear, which can cause irreparable harm. I have asked many patients why insulin scares them.

It is usually fear of the injection, concern over weight gain, worry about hypoglycemia. Yes, insulin, like every other medication, has the potential for side effects, some serious. But if you are not producing enough on your own, you will have a hard time getting your blood sugars under control. I have had patients come in on five oral diabetes medications and still have blood sugar levels two or three times what is normal. As for the pain of injections, it is minimal. Most patients don’t even feel them. Weight gain can occur because, for some people, insulin is an invitation to eat whatever they want. That may include doughnuts for breakfast, with extra insulin. Once you are comfortable using insulin, you have more individual control of your diabetes, but dietary control is still important.

Probably the most important factor for seniors is the cost, specifically when they hit their Medicare coverage gap. Newer non-generic medications are expensive, but when you “enter the doughnut hole,” the prices increase significantly. For some seniors, they stop taking their medication entirely. For others, they take less than needed. There are income-based assistance programs that may be able to help you through the coverage gap, so ask your provider about these, too. About 60 percent of my patients qualify for a very helpful program provided by the state of Nevada.

Diabetes is not fun, but it is treatable. The truth is it takes less than 10 minutes of the day to manage diabetes with medications and blood glucose checks. Approaching diabetes from several directions, including diet, exercise and medications, can reduce, if not eliminate, diabetes-related complications. It is important to be knowledgeable about the disease, the treatments available and your specific goals.

Seniors have very specific barriers to overcome, but hopefully this can be done a little more easily. Please talk with your provider, come up with a game plan that works for you and do your part to get this disease, your disease, under control.

Roslyn Collins specializes in endocrinology at Southwest Medical Associates.

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