Diabetes management can be a long and difficult road, one that often grows more complicated with age. While taking an active and engaged approach to managing your diabetes is important to reduce the risk of complications, there is no guaranteed way to avoid them after a lifetime of living with diabetes. Add in the sort of age-related issues that can affect everyone and suddenly managing your health can feel like a full-time occupation.
Jennie Prest has had type 1 diabetes for four decades and, despite carefully managing her blood glucose levels over that time, is now finding herself dealing with a growing list of complications. She says there needs to be greater awareness that some complications simply can’t be avoided as you get older.
“It’s a major bee in my bonnet,” Jennie says. “Everywhere you see reference to diabetes, it says complications arise because you badly managed your diabetes, because you didn’t do this or that or whatever. And that just isn’t the case.”
Having to keep on top of a lengthening list of specialist appointments and medications can feel like a full time job as we get older.
Now in her 70s, Jennie is experiencing eye problems and neuropathy, which can result from decades of fluctuating blood glucose levels — no matter how fastidious you might be about diabetes management. She says it can be a source of stigma for older people living with type 1.
“It’s such a guilt trip. Nobody’s perfect, but you know, I’ve done pretty well with management all the way through and I’m still gradually getting all the complications now. And I feel awful being told, ‘Oh, so you didn’t manage it?’ I did!”
Jennie would also like to see greater acknowledgment that management isn’t just a case of exercising more and eating fewer carbs. A range of other factors can affect blood glucose levels as you age — including stressing out about managing your diabetes.
“I’ve spent many years feeling guilty when my blood sugar went up because I didn’t realise that it could be raised by fear, anxiety, stress, anything like that. These are things you can’t necessarily avoid.”
In other words, even when you try your best, life can get in the way when it comes to managing a chronic condition such as diabetes. These disruptions tend to become more frequent as we age and can often interfere with successfully managing a chronic condition.
Jennie says that having to keep on top of a lengthening list of specialist appointments and medications can feel like a full time job as we get older.
Ageing healthily with a chronic condition
Professor Leon Fickling AO of the University of Western Australia says that while age brings a long list of new conditions which can make life more difficult, we should resist the temptation to see age itself as a chronic illness.
“There is a view of frailty and this idea that, as you get older, there’s physiological changes which inevitably occur, and I’m not a great fan of that thinking,” Leon says.
What is more helpful, he says, is for people to think more seriously about the specific sort of conditions to which we are all more prone as we age. Arthritis, for example, is probably the largest cause of disability in all people, but its association with ageing means that it tends not to be considered very important.
“There are a range of conditions that become more common as you get older. Mental health issues, not just dementia but also anxiety and depression. Sensory problems such as hearing. These are conditions that won’t kill you — apart from dementia — but they can certainly make you miserable.”
“As you get older, physical activity becomes even more important. The problem is that you may not be able to do that physical activity.”
The risk of these age-related conditions tends to be higher for people who are already living with diabetes. Adding further chronic conditions to an existing one can make successful management seem almost impossible.
“There’s lots of reasons why it can become difficult as you age. Firstly, diabetes makes you more prone to all the other health conditions like heart attacks, strokes, peripheral vascular neuronal loss, all those things. Diabetes also makes you more likely to get dementia and probably makes you more likely to get depressed. And, of course, the risk of type 2 diabetes increases dramatically in older people.”
There’s also the simple matter of not being able to follow the sort of exercise regime that might have worked for you in your youth. But there are some general rules of thumb, Leon says, about finding a workable level of activity in old age.
“As you get older, physical activity becomes even more important. The problem is that you may not be able to do that physical activity. There are lots of physical activity programmes around, but people who are frail probably should attend specific sessions run by exercise physiologists or physiotherapists. Everybody can do some sort of exercise, but the ratio is about how you can do that safely.”
Getting help Leon recommends the ICOPE (Integrated Care for Older People) framework created by the World Health Organisation as an ideal basis to supporting healthy ageing. The framework’s guidelines are designed to support health professionals in assessing older people’s health and meeting their needs.
These guidelines are based on the best available evidence on what works to prevent, slow or reverse declines in the physical and mental capacities of older people.
With that in mind, if someone is starting to find it more difficult to manage a chronic condition such as diabetes, how would Leon recommend they seek help?
“Well, normally your GP is your first point of call, as often there are services that the GP can organise. I think the important thing is you need to get good advice when you start getting health conditions. Sometimes people think there’s nothing that can be done and normally there’s lots that can be done. The non-pharmacological strategies are really, really important.”
Non-pharmacological strategies include physical activity as well as things like staying involved with your local community and maintaining crucial social contact. But it’s important that people don’t feel that they are individually responsible for tackling the causes of chronic conditions such as diabetes.
“I think it’s important to take a holistic approach,” Leon says. “You can’t talk about healthy or successful ageing without talking about medical care, but there’s also the rest of the society and environment, which is really important as well.”
If we want to start ageing more healthily as a society, we need to rethink our approaches on a range of different issues.
“We could all try to make sure that food doesn’t contain additives that make that food almost addictive. We need to encourage physical activity by making cities more walker friendly and safer for older people. We need to make sure that the pavements are safe to walk on. We need to have well-lit streets that people can walk at night at night and not feel like they’re going to be attacked. They all sound like such little things, but cumulatively they’re important.”
A good life
On Jennie’s part, she would like to see a little more awareness of the difficulties in managing type 1 diabetes into older age.
“For people in my age bracket, being judged for developing complications feels like a slap in the face. If you’ve come through all the hassles that everybody goes through in life plus managing your diabetes and everything else at the same time, you’ve done bloody well!” At the same time, she’s keen for younger people with type 1 to know that their choices now do make a big difference later on.
“You can live a good life with type 1 diabetes. It has its ups and downs, but you’ve got to live a normal life while managing your diabetes which can be hard to do. But there are things out there to help you as you get older. I’ve joined a walking group, which is great, because it just keeps that momentum of exercise going. Things like that, in your local community, can be very positive.”
