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CLINICAL PRESENTATION AND MANIFESTATIONS:
Presentation of DM in the elderly may be confounding. At one extreme, routine screening is recommended, as they may be totally asymptomatic. At the other extreme, patients may have a host of dramatic symptoms attributed to other organ system problems. Urinary incontinence, mono-oculo neuropathy, and onset of sexual dysfunction are sometimes the first noticed symptoms in an elderly diabetic. They may also present with a minor infection that is difficult to control. A high index of clinical suspicion is necessary for all clinicians managing the elderly, and blood glucose concentration should be measured following any change of health status in the older people.
Several unique syndromes occur in elderly patients with diabetes. Diabetic neuropathic cachexia presents with weight loss, depression, and painful peripheral neuropathy, and generally is resolved without specific treatment in a few months. Diabetic amyotrophy occurs almost exclusively in older men with diabetes. Malignant otitis externa, a necrotizing infection usually caused by pseudomonas, occurs primarily in elderly diabetics. The papillary necrosis that can occur with pyelonephritis develops primarily in this group. Spontaneously resolving intradermal bullae of the feet and the painful limitation of shoulder movements as in periarthritis of shoulder also occur. Finally, elderly persons with diabetes are at an increased risk of accidental hypothermia.
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