So far, Orra Larson recognizes what’s happening. “I feel like you’re shaking inside,” she said. “I was faster. I’m anxious. ” If someone asks if she wants a salad for lunch, she doesn’t know how she responds.
She had some episodes this year and seems to come more often.
Her daughter Susan Larson (61) said, “She looks at gray and becomes gray and confuses.” “It’s really scary.”
Hypoglycemia occurs when blood sugar or glucose levels are too low. Reading less than 70 milligrams per decey liter is a definition that is allowed. You can bother people who control the condition using glucose lowers.
But it occurs more often in high -end age. “It is possible that I have experienced episodes if I have been diabetics for years,” said Sei Lee, an elderly therapist at the University of California of San Francisco.
Elder Larson at the age of 85 had been suffering from type 2 diabetes for decades. Her endocrine scholars and primary doctors are now worried that hypoglycemia can cause fall, broken bones, heart arrhythmia and cognitive damage.
Both advised her to make the Hemoglobin A1C, an average scant of the average blood sugar, exceeded 7 %. Larson said by a young man.
But her mother spent 35 years to keep A1C less than 7 %. Common recommendations, people sang and dance in pharmaceutical advertisements.
She faithfully injects Victoza, a drug prescribed three times a week, and watches her diet. She is the oldest member of the Aqua for ATTHRITIS class in a local swimming pool in St. Paul, Minnesota.
So when her doctor recommended that A1C was higher, she resisted. “I think it’s a lot of arc,” she said. “It didn’t make sense to me.”
Her daughter said, “She controlled diabetes and stayed on it and was very encouraged and recognized by her doctors. “They always praised her ‘tight control’.”
“It’s like changing the rules for those who have been so observed for this few years.”
In fact, they have.
10 years ago, The American Society for Elderly demanded 7.5-8 hemoglobin A1C from most elderly people. For those who have a limited number of chronic diseases and life expectancy, diabetes is 8-9 %. (Elder Larson has multiple sclerosis and hypertension.)
Other medical societies and advocates American Diabetes Association and Endocrine societyIn addition, the guidance of the elderly patients was modified.
Relaxing aggressive treatment can include stopping drugs, lowering doses, or switching to other drugs.
The emergence of effective new diabetes drugs, GLP-1 receptors (such as Ozempic) and SGLT2 inhibitors (such as jardiance), further changes the environment. Some patients can replace these safe drugs for a dangerous patient.
But new drugs can complicate the decision because not all elderly patients can switch. And for those who are possible, insurance companies can be caught in the high -priced tags of new medicines and reject the scope of coverage.
Therefore, the waste is in progress Too gradually.
2021 Study on Medicare beneficiaries with diabetesFor example, I saw a patient who went to the emergency room or was hospitalized due to hypoglycemia. Less than half the drug therapy removed the senses within 100 days.
“Nursing home Dr. Joseph Ouslander, an elderly and doctor of Florida Atlantic University, and Dr. Joseph Ouslander, editor -in -chief of the American Society.
Another 2021 Ontario Nursing Home ResearchMore than half of the residents taking type 2 diabetes drugs were less than 7 % of A1C. Those with the largest cognitive impairment were most active.
Dr. OUSLANDER calculated accordingly National researchExcessive treatment of the elderly’s diabetes from 2007 to 2011, resulting in about 40,000 emergency room visits every year. I think the number will be much higher now..
Simple primer: Diabetes can cause strict blood sugar control, such as heart attack, stroke, vision and hearing, chronic kidney disease, and cutting, such as heart attacks such as young adults and middle -aged heart attacks.
However, like all treatments, strict control includes a certain time before paying money to improve health. Diabetes is a long time, perhaps 8-10 years.
Already, the elderly who cope with various health problems may no longer live long enough to benefit from close control. Dr. said, “It was really important when I was 50 years old. “It’s less important now.”
Old diabetics patients do not always welcome this news. “I thought they would be happy,” Dree said. “It’s almost the same as I’m trying to take something.”
The risk of strict control of hypoglycemia increases with the age of the patient.
It can sweat and make people embarrassed and tired. When hypoglycemia is severe, “People can lose consciousness. “They can be confused. If they drive, they can be accidents. ”
Even mild hypoglycemia incidents can be qualified if they occur frequently. It causes anxiety He added that he would lead patients to limit their activities.
Experts point out two kinds of old drugs, especially related to hypoglycemia: insulin and Seol Ponyl Urea Like glyburide, glipizide and glimepiride.
Hormonal injections are essential for patients with type 1 diabetes whose body cannot produce insulin. But this drug is “widely known as a dangerous drug” due to the risk of hypoglycemia, and Dr. LEE said carefully.
He added that the Sol phonylurea is not more dangerous than insulin, but it causes hypoglycemia.
The majority of the elderly with diabetes have two types, providing more options. They can generally be prescribed with new GLP-1 and SGLT2 drugs, which have the advantages of heart and kidney. If necessary, they can add insulin to the therapy.
But the most popular result of the new drug is weight loss.
Dr. Pilla said, “If you are not weak and active for the elderly, you do not want to lose weight. And both metformin and GLP-1 and SGLT-2 drugs can have gastrointestinal or reproductive side effects.
For 15 years, Dan Marsh, 69, a media accountant in Pennsylvania, has injected two types of insulin every day to treat type 2 diabetes. When he took too much, he said he had to wake up with “the lowest point” at night and eat and take glucose tablets.
But his A1C was still high and last year, the doctor cut some of the toes. He and his doctor decided not to try other diabetes drugs because they took many other drugs for various conditions.
Marsh said, “I know there are other things, but we didn’t go that way.
Dr. Pilla said through all the new options, including ongoing glucose monitors, “It is becoming increasingly difficult to identify the optimal treatment.
But in conclusion, “the elderly overestimate the benefits of blood cuts and underestimate the risk of drugs,” he said. often, Their doctors did not explain how the tradeoff changed as old as he got older. Accumulate health problems.
In the case of hypoglycemia (fruit juice and candy rods are also popular antidote), Ora Larson, who has glucose purification that can be chewed with her, wants to talk about the treatment of doctors and diabetes.
A good idea. Dr. said, “The biggest risk factor for severe hypoglycemia is the previous hypoglycemia.
“If you have one episode, you should think of it as a warning signal. Why is this happening to be incumbent to a doctor? What can we do so that your blood sugar is not dangerous? ”
