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/

New study highlights stressors of living with Type 1 diabetes as an older adult

From sph.unc.edu

People diagnosed with Type 1 diabetes (T1D), formerly called juvenile diabetes, learn many strategies for self-management that must evolve as they age.  Despite advances in treatment, the burdensome nature of managing T1D – including non-stop glucose monitoring, dosing insulin, and responding to episodes of dangerous low blood– contributes to “diabetes distress,” a term for the expected burdens, concerns and fears related to living with and managing diabetes.

As treatments and technologies improve, the number of older adults living with T1D has grown. Studies have explored facets of T1D management that can be stressful for children and young adults as they learn to live with their condition, but little research has focused on the way those stressors can shift with age.

A new UNC-led study, published in the Journal of Diabetes and Its Complications, is the first to highlight diabetes distress that people over the age of 65 can encounter when managing T1D, including the unique stressors in this age group. While the researchers found that markedly elevated levels of diabetes distress were less prevalent among older adults than in younger age groups, understanding the sources of that distress – and the people most likely to experience it – will help health care and public health experts improve treatment strategies for this unique population.

Dr. Anna Kahkoska

“Screening for and addressing diabetes distress is now recognized as an important part of diabetes care,” said Anna R. Kahkoska, MD, PhD, senior author and Joan Heckler Gillings Assistant Professor of nutrition at the UNC Gillings School of Global Public Health. “Not only does diabetes distress worsen quality of life, but it can also directly interfere with self-management, resulting in worse health outcomes. Given that so much can change in older adulthood, we were interested in understanding how diabetes distress impacts older adults living with T1D.”

Around 36% of older adults surveyed in the study reported elevated levels of diabetes distress warranting further assessment and treatment. Older adults who identified as women, had higher haemoglobin A1C levels and had been to the emergency room in the past year were most likely to experience elevated levels of diabetes distress. The most common stressors included financial worries, T1D management difficulties and worries about complications.  An unexpected finding was that people who had been diagnosed with T1D at earlier ages or had lived with the condition the longest had lower levels of diabetes distress.

“These data highlight new opportunities to improve diabetes care for older adults with T1D by providing more support for the stressors in this age group, as well as interventions focused on the specific subpopulations who may be at the highest risk of having elevated distress,” Kahkoska said. “For example, older adults may benefit from additional guidance to navigate age-related changes in their self-management routines, including changes in employment and insurance coverage that impact someone’s ability to obtain all the supplies they need.”

Adriana Wisniewski

“This work serves as a foundation for diabetes distress research focused on the experiences of older adults with T1D,” said lead author Adriana Wisniewski, a doctoral student in anthropology at the UNC College of Arts and Sciences. “Our group hopes to continue exploring the specific factors and experiences that contribute to diabetes distress in this population, and this study has highlighted areas for potential next steps. This work also closely aligns with ongoing projects our research team is conducting, including a clinical trial, ChargeUp.”

The ChargeUp study is a virtual clinical initiative focused on reducing diabetes distress among adults with T1D, including older adults. Wisniewski said the findings of this study have helped the research team better understand what specific factors may be important to emphasize, explore or be more sensitive to when working with older adult participants in ChargeUp.

Learn more about ChargeUp from the North Carolina Translational and Clinical Sciences Institute.

Researchers on the study include Wisniewski; Kahkoska; biostatistics doctoral student Justin DeMonte, alumna Angelica Cristello Sarteau, PhD, and senior project manager in nutrition Angela Fruik, MPH, from the Gillings School; and Ruth S. Weinstock, MD, PhD, from SUNY Upstate Medical University.

https://sph.unc.edu/sph-news/new-study-highlights-stressors-of-living-with-type-1-diabetes-as-an-older-adult/ 

7-Day Diabetes Meal Plan for Healthy Aging, Created by a Dietitian

From eatingwell.com

This meal plan is full of fibre, protein, calcium and vitamin D for healthy muscles, bones and blood sugar levels

ABOUT THIS PLAN

• This 7-day plan is set at 1,800 calories, with modifications for 1,500 and 2,000 calories.
• Each day provides at least 80 grams of protein and 30 grams of fibre to support healthy aging, balanced blood sugars, cardiovascular health, digestion and more. 
• This plan prioritizes key nutrients for healthy aging, including protein, fibre, calcium and vitamin D.

Almost 15% of U.S. adults have diabetes, yet learning how to manage it may feel overwhelming.

Centers for Disease Control and Prevention. National Diabetes Statistics Report.

 That’s why we created this meal plan. Each meal and snack meets our diabetes-appropriate nutrition guidelines designed to support healthy blood sugar levels and prevent heart disease. Since diabetes rates are higher among older adults, we also made sure to focus on key nutrients for promoting muscle mass, heart health and bone density as you age—protein, calcium, vitamin D and fibre. In fact, each day provides at least 80 grams of protein and 30 grams of fibre. Even if you haven’t hit 60 yet, it’s never too early to start prioritizing these nutrients so you can age with grace.

Meal Plan at a Glance
Breakfast/ A.M. Snack	Lunch/ P.M. Snack	Dinner/ Evening Snack
French toast & berries/ Mixed nuts	Tuna rice bowl/ Cocoa chia pudding	Sweet chili salmon bowl
Vanilla-cranberry overnight oats/ Yogurt parfait	Chickpea salad lunch box/ Cocoa chia pudding	Balsamic chicken with arugula salad/ Crunchy chickpeas
Vanilla-cranberry overnight oats/ Edamame	Chickpea salad lunch box/ Cocoa chia pudding	Mojo chicken with veggies/ Crunchy chickpeas
Vanilla-cranberry overnight oats/ Mixed nuts	Chickpea salad/ Edamame	Creamy pesto shrimp & gnocchi/ Yogurt parfait
Yogurt parfait/ Mixed nuts	Chickpea salad/ Cottage cheese snack jar	Spicy chicken & cabbage stir-fry/ Apple & nut butter
Yogurt parfait/ Edamame	Chicken & feta wrap/ Cottage cheese snack jar	Chicken with rice & green beans/ Apple & nut butter
Yogurt parfait/ Edamame	Chicken & feta wrap/ Cottage cheese snack jar	High-protein pasta with peas/ Yogurt parfait

Day 1 

Air-Fryer French Toast Sticks.

Jason Donnelly

Breakfast (403 Calories) 

• 1 serving Air-Fryer French Toast Sticks
• ½ cup fresh blueberries
• ½ cup low-fat plain strained (Greek-style) yogurt

Morning Snack (199 Calories) 

• ¼ cup unsalted dry-roasted mixed nuts 

Lunch (394 calories) 

• 1 serving Canned Tuna Rice Bowl

Afternoon Snack (222 Calories) 

• 1 serving Cocoa-Chia Pudding with Raspberries

Dinner (604 Calories) 

• 1 serving High-Protein Thai Sweet Chili Salmon Bowl
• ⅓ avocado

Daily totals: 1,822 calories, 88 g fat, 93 g protein, 168 g carbohydrates, 34 g fibre, 1,724 mg sodium

To make it 1,500 calories: Omit morning snack and omit avocado from dinner.

To make it 2,000 calories: Add ¼ cup hummus with 1 cup cucumbers as an evening snack. 

Day 2

Easy Chickpea Salad Lunch Box.

Ali Redmond

Breakfast (422 Calories) 

• 1 serving Vanilla-Cranberry Overnight Oatmeal

Morning Snack (125 Calories) 

• ½ cup low-fat plain strained (Greek-style) yogurt
• ½ cup fresh blueberries

Lunch (422 calories) 

• 1 serving Easy Chickpea Salad Lunch Box

Afternoon Snack (222 Calories) 

• 1 serving Cocoa-Chia Pudding with Raspberries

Dinner (485 Calories) 

• 1 serving Balsamic Chicken Thighs with Arugula-Tomato Salad
• ¾ cup cooked whole-wheat penne

Evening Snack (100 Calories) 

• 1 serving Crunchy Roasted Chickpeas

Daily totals: 1,776 calories, 81 g fat, 90 g protein, 190 g carbohydrates, 44 g fibre, 1,399 mg sodium

To make it 1,500 calories: Omit blueberries from morning snack and omit afternoon snack. 

To make it 2,000 calories: Increase morning snack to 1 cup low-fat plain strained (Greek-style) yogurt with 1 cup blueberries and add ½ cup low-fat plain strained (Greek-style) yogurt and ¼ cup cucumbers to evening snack to make a savoury yogurt bowl.

Day 3

Sheet-Pan Mojo Chicken with Green Beans & Potatoes.

Photographer: Jake Sternquist, Food Stylist: Shannon Goforth, Prop Stylist: Breanna Ghazali.

Breakfast (422 Calories) 

• 1 serving Vanilla-Cranberry Overnight Oatmeal

Morning Snack (129 Calories) 

• 1 cup edamame, in pods (microwaved from frozen) 

Lunch (505 calories) 

• 1 serving Easy Chickpea Salad Lunch Box
• ½ cup low-fat plain strained (Greek-style) yogurt

Afternoon Snack (222 Calories) 

• 1 serving Cocoa-Chia Pudding with Raspberries 

Dinner (413 Calories) 

• 1 serving Sheet-Pan Mojo Chicken with Green Beans & Potatoes

Evening Snack (100 Calories) 

• 1 serving Crunchy Roasted Chickpeas

Daily totals: 1,790 calories, 85 g fat, 94 g protein, 181 g carbohydrates, 49 g fibre, 1,422 mg sodium

To make it 1,500 calories: Omit yogurt from lunch and omit afternoon snack. 

To make it 2,000 calories: Add ⅓ avocado to dinner and add ½ cup low-fat plain strained (Greek-style) yogurt and ¼ cup cucumbers to evening snack to make a savoury yogurt bowl.

Day 4

Creamy Pesto Shrimp with Gnocchi & Peas.

Photographer: Greg DuPree, Prop stylist: Shell Royster, Food stylist: Emily Hall

Breakfast (422 Calories) 

• 1 serving Vanilla-Cranberry Overnight Oatmeal

Morning Snack (199 Calories) 

• ¼ cup unsalted dry-roasted mixed nuts 

Lunch (422 calories) 

• 1 serving Easy Chickpea Salad Lunch Box 

Afternoon Snack (129 Calories) 

• 1 cup edamame, in pods (microwaved from frozen) 

Dinner (409 Calories) 

• 1 serving Creamy Pesto Shrimp with Gnocchi & Peas

Evening Snack (250 Calories) 

• 1 cup low-fat plain strained (Greek-style) yogurt
• 1 cup blueberries 

Daily totals: 1,830 calories, 86 g fat, 87 g protein, 192 g carbohydrates, 37 g fibre, 1,222 mg sodium

To make it 1,500 calories: Omit morning and afternoon snacks. 

To make it 2,000 calories: Add ¼ cup hummus with 1 cup cucumbers to afternoon snack.

Day 5

Everything Bagel Cottage Cheese Snack Jar with Bell Peppers and Chickpeas.

Photographer: Jen Causey, Food Stylist: Chelsea Zimmer, Prop Stylist: Claire Spollen

Breakfast (381 Calories) 

• 1 serving Strawberry & Yogurt Parfait
• 2 Tbsp. chopped walnuts

Morning Snack (199 Calories) 

• ¼ cup unsalted dry-roasted mixed nuts 

Lunch (422 calories) 

• 1 serving Easy Chickpea Salad Lunch Box

Afternoon Snack (195 Calories) 

• 1 serving Everything Bagel Cottage Cheese Snack Jar with Bell Peppers & Chickpeas

Dinner (392 Calories) 

• 1 serving Spicy Chicken & Cabbage Stir-Fry

Evening Snack (190 Calories) 

• 1 medium apple
• 1 Tbsp. natural peanut butter

Daily totals: 1,779 calories, 81 g fat, 93 g protein, 173 g carbohydrates, 34 g fibre, 1,406 mg sodium

To make it 1,500 calories: Omit walnuts from breakfast and omit evening snack . 

To make it 2,000 calories: Add 1 Tbsp. chia seeds to breakfast, add ½ cup blueberries to morning snack, and add 1 cup edamame, in pods (microwaved from frozen) to dinner.

Day 6 

Chicken, Spinach & Feta Wrap.

Photographer: Grant Webster, Food Stylist: Addelyn Evans, Prop Stylist: Gabe Greco

Breakfast (381 Calories) 

• 1 serving Strawberry & Yogurt Parfait
• 2 Tbsp. chopped walnuts

Morning Snack (129 Calories) 

• 1 cup edamame, in pods (microwaved from frozen) 

Lunch (457 calories) 

• 1 serving Chicken, Spinach & Feta Wraps
• ½ cup cucumber
• ¼ cup hummus 

Afternoon Snack (195 Calories) 

• 1 serving Everything Bagel Cottage Cheese Snack Jar with Bell Peppers & Chickpeas

Dinner (459 Calories) 

• 1 serving Garlic-Thyme Chicken with Green Beans & Rice

Evening Snack (190 Calories) 

• 1 medium apple
• 1 Tbsp. natural peanut butter 

Daily totals: 1,810 calories, 78 g fat, 124 g protein, 160 g carbohydrates, 36 g fibre, 1,547 mg sodium

To make it 1,500 calories: Omit morning and evening snacks. 

To make it 2,000 calories: Add 1 Tbsp. chia seeds to breakfast, add ½ cup blueberries to morning snack, and add ⅓ avocado to lunch wrap.

Day 7 

High-Protein Pasta with Peas.

Photographer: Morgan Hunt Glaze, Prop Stylist: Claire Spollen, Food Stylist: Chelsea Zimmer

Breakfast (381 Calories) 

• 1 serving Strawberry & Yogurt Parfait
• 2 Tbsp. chopped walnuts

Morning Snack (129 Calories) 

• 1 cup edamame, in pods (microwaved from frozen)  

Lunch (457 calories) 

• 1 serving Chicken, Spinach & Feta Wraps
• ½ cup cucumber
• ¼ cup hummus 

Afternoon Snack (195 Calories) 

• 1 serving Everything Bagel Cottage Cheese Snack Jar with Bell Peppers & Chickpeas

Dinner (414 Calories) 

• 1 serving High-Protein Pasta with Peas

Evening Snack (250 Calories) 

• 1 cup low-fat plain strained (Greek-style) yogurt
• 1 cup blueberries 

Daily totals: 1,825 calories, 71 g fat, 119 g protein, 181 g carbohydrates, 35 g fibre, 1,369 mg sodium

To make it 1,500 calories: Omit morning and afternoon snacks. 

To make it 2,000 calories: Add 1 Tbsp. chia seeds to breakfast and add ⅓ avocado to lunch wrap.

Prep-Ahead Tips

• Prep all 3 servings of the Cocoa-Chia Pudding with Raspberries for snacks on Days 1 through 3 at once and refrigerate them until it’s time to eat.
• Prep the Vanilla-Cranberry Overnight Oatmeal for breakfast on Days 2 through 4 at once. It stays good in the fridge for up to 2 days.
• Prep the Easy Chickpea Salad Lunch Box for lunch on Days 2 through 5 at once. It stays good in the fridge for up to 3 days.
• If you don’t mind them losing a little crisp, make the Crunchy Roasted Chickpeas for snacks on Days 2 and 3 at once. Otherwise, it’s best to prep them fresh each night so they’re crunchy.
• Prep the Everything Bagel Cottage Cheese Snack Jars for snacks on Days 5 through 7 at the same time (up to 4 days in advance). Just wait to add the crispy chickpeas until you’re ready to eat so they won’t get soggy.

Other Tips for Healthy Aging

Besides eating a well-rounded diet with plenty of fruits, veggies, whole grains, lean proteins and healthy fats, there are a few other lifestyle changes you can make for healthy aging. For one, try to stay active through a mix of aerobic activity, muscle-strengthening and balance work. This promotes heart health, metabolic health and helps prevent falls. It also helps combat age-related losses in muscle mass and bone density.

Also, don’t underestimate the importance of a good night’s sleep. This is when your body and brain slow down to rest and recover from the wear-and-tear of the day. Studies show that not getting enough quality sleep is linked with higher rates of depression, dementia, falls and cognitive decline. Other things that support healthy aging include keeping up with regular check-ups with your health care providers, minimizing your alcohol intake, quitting smoking, regularly socializing and keeping your mind active through reading, writing or games.

How We Create Meal Plans

Registered dietitians thoughtfully create EatingWell’s meal plans to be easy-to-follow and delicious. Each meal plan meets specific parameters depending on the health condition and/or lifestyle goal it is targeting and is analysed for accuracy using the nutrition database, ESHA Food Processor. As nutritional needs differ from person to person, we encourage you to use these plans as inspiration and adjust as you see fit.

https://www.eatingwell.com/7-day-healthy-aging-meal-plan-for-diabetes-11830086