Type 2 diabetes over time: What to expect as you age

From mcpress.mayoclinic.org

By Jessica R. Wilson, M.D.

Type 2 diabetes is one of the most common chronic conditions in the U.S. The way it affects each person, however, often varies substantially.

If you have type 2 diabetes, your age and the length of time since you were diagnosed are two major factors likely to influence your condition. Understanding these factors and anticipating changes can help you and your care team create a diabetes management plan that offers you ideal support now and for years to come.

How insulin production and insulin resistance change over time

When you eat food, your body breaks it down into a type of sugar called glucose. Glucose is fuel for your body’s cells. It enters your blood and gets into your cells with help from a naturally occurring hormone called insulin.

All forms of diabetes stem from an insulin issue. If you have type 2 diabetes, your body either doesn’t make enough insulin, can’t use insulin effectively or both. This causes glucose to build up in your blood. If your blood glucose level is too high, too often, it can cause issues throughout your body.

Your amount of insulin and its effectiveness tend to change over time. “It’s a supply and demand issue,” says Jessica R. Wilson, M.D., M.S., an endocrinologist and diabetes expert at Mayo Clinic in Jacksonville, Florida.

When you’re first diagnosed with type 2 diabetes, your pancreas — a vital organ in your abdomen — is typically able to produce insulin. However, the amount produced isn’t enough to match the demand. Type 2 diabetes also makes your cells less sensitive to insulin — a phenomenon known as insulin resistance. This means that more of the hormone is required to move sugar from your bloodstream into your cells.

Insulin resistance pushes the pancreas to produce more insulin. For some people, the pancreas is able to keep up with high demand. For others, it might not. Pancreas damage and age both can lower insulin production, says Dr. Wilson.

To address insulin supply and demand issues, people who have type 2 diabetes often take a medicine designed to lower their demand for insulin. If this isn’t enough to balance supply and demand or if their insulin production drops over time, extra insulin might be needed. This is known as insulin therapy.

Rarely will a person who has diabetes use the same treatment for a lifetime. Certain medicines may become less effective after a while. Switching to a different therapy could make it easier to manage blood glucose. Other factors such as diet and exercise might lower blood glucose and eliminate the need for one or more medicines.

The risk of type 2 diabetes complications can increase over time

Most people who have type 2 diabetes have an elevated risk of complications. Because blood flows throughout the entire body, the impacts of high blood glucose levels can affect many organs and structures. Common type 2 diabetes complications include issues in the heart, kidneys, nerves, eyes and feet.

Effective diabetes management can reduce these risks. Research shows that people with sustained high blood glucose have an elevated risk of developing a complication within the next 10 years. In comparison, people with blood glucose levels that are within the diabetic range, but are near the low end of that range, are less likely to develop a complication within the next 10 years.

Still, any level of sustained elevated blood glucose, including living with a blood glucose level in the prediabetes range, can increase the risk of complications. In addition, the risk of developing complications may be further elevated if you’re an older adult.

Regardless of your age or how long you’ve had diabetes, it’s important to monitor more than just your blood glucose. According to Dr. Wilson, you should start routine screenings for common complications immediately after you’ve been diagnosed with type 2 diabetes. This testing helps your care team identify and address any issues early on.

Why early type 2 diabetes treatment matters

Starting a diabetes management plan immediately after you’re diagnosed can limit the amount of time your blood glucose is too high. Additionally, some research suggests that treating type 2 diabetes early and intensively can create a “legacy effect.” By quickly lowering your blood glucose level with lifestyle changes, medications or other methods, you may have a lower long-term risk of complications, even if your level rises in the future.

Some diabetes treatments are more effective for people with a recent diabetes diagnosis. Metformin is a common diabetes medicine that lowers blood glucose in part by improving insulin sensitivity in the body’s cells. Research suggests that beginning treatment with metformin in the early stages of diabetes — before insulin production may have declined substantially — can lower blood glucose more effectively than starting the medicine later on.

How age influences type 2 diabetes management

Several factors influence how diabetes may affect you. Ethnicity, sex, genetics and other traits all play a part in the condition and are worth considering when planning your diabetes management strategy.

Age is one of the most influential factors in diabetes management. As part of a management strategy, a 30-year-old who has diabetes might benefit from a combination of medicines designed to quickly lower blood glucose. A 70-year-old with diabetes might benefit especially from a plan that includes weight-bearing exercise, such as walking or strength training. These types of activity may simultaneously help with losing excess body weight and preserving bone density, which naturally declines with age.

To ensure that you’re following the best management plan for your diabetes, consult healthcare professionals you trust. Finding a capable care team that recognizes your distinct needs and helps you build a personalized plan is a critical first step toward improved wellness.

https://mcpress.mayoclinic.org/diabetes/type-2-diabetes-over-time-what-to-expect-as-you-age/