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Diet:
Many elderly are managed with diet alone with various degrees of success. But, the elderly may find it more difficult to adhere to a strict dietary regimen than young adults. Moreover, there are many special considerations in the elderly like financial difficulties, mobility problems, poor food preparation skills, long-standing dietary habits, difficulty in following dietary instructions, decreased sense of taste and increased frequency of constipation, which hinder their ability and motivation to follow the advised dietary protocol. It is important to tailor the dietary advice to the individual patient. Unnecessarily strict dietary control in a very old person with a short life expectancy may reduce the quality of life without any significant therapeutic benefits.
No specific modifications in the diet is currently recommended by the ADA have been recommended for older diabetics. However, vitamin and mineral supplements are indicated when the caloric intake falls below 1000 kilocalories per day to prevent deficiency syndromes.
Exercise:
The role of exercise as therapy in elderly diabetics is controversial. One study suggests that exercise, as a significant therapy for control of DM may not be feasible for older adults.
Table 3: Potential benefits and risks of exercise in elderly diabetics.
Benefits | Risks | Improved exercise tolerance Improved glucose tolerance Improved maximal O2 consumption Increased muscle strength Decreased blood pressure Decreased body fat Increased muscle mass Improved lipid profile Improved sense of well being | Sudden cardiac death Foot and joint injuries Hypoglycemia |
There are many potential benefits along with certain risks (Table 3). Most of the benefits are related to the improvements in the risk factors for cardiovascular disease, which is a significant complication of diabetes in the elderly. Because of the prevalence of silent coronary artery disease in this population, older adults with diabetes should undergo an exercise tolerance test in consultation with their treating physicians before they begin any exercise programme. The level of exercise should be gradually increased and tailored to the exercise capacity of the patient. Patients must wear proper footwear during exercise, and care must be taken to avoid injury and falls that can be disastrous in the elderly. Hypoglycemia must be avoided by adequate snacks before starting the exercise.
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