An individualized approach to treatment
“Guidelines from the American Geriatrics Society for diabetic care in older adults stress an individualized approach to care,” Pinkstaff says. “That’s  because older adults can have so many other conditions. You have to look at the whole picture to develop the right treatment plan.”

It’s a complex process because every person is different. “We look at diabetic patients the same way we look at all of our patients—as a whole entity, not just as having one type of problem,” Lascari says. “It can make a big difference for someone’s quality of life.

“The main goal of treatment is to control the diabetes  the best we can,” he adds. “When someone has uncontrolled diabetes, they age much more rapidly internally than the average person that has controlled diabetes.”

Keeping diabetes under control
“A glycosolated hemoglobin, or A1c test, done every three months or so gives us an idea of how well someone’s diabetes has been controlled,” Lascari says. “And in cases where people can’t do their blood sugars because of arthritis, or they can’t maneuver the strips or read the machines very well, we can still see how they’re doing by following their A1c results.

“We’re not only interested in their blood sugars, we’re also interested in their cholesterol level, especially their ‘bad’ cholesterol, or LDL,” he adds. “If we find their LDLs are high, we may want to put them on a medication that can help with that problem.”

Lascari says that he’d like adults with diabetes to have cholesterol and LDL levels a bit lower than adults without diabetes. “And besides cholesterol, we have to look at other factors that may be affecting their heart or other organ systems. Things like high blood pressure, smoking, a high-fat diet, or lack of exercise. We try to help our residents cut down on as many cardiac risk factors as possible,” he says.

Ongoing education
Education should be a big part of the visit with your health provider. “We review weight control, proper diet, and exercise programs,” Lascari says. “For example, if we want residents to exercise to benefit their hearts, we caution them that the more exercise they do, the lower their blood sugars might become. We review residents’ diets to see how they can be improved with respect to lowering cholesterol and salt.”

Lascari summarizes, “If you put it all together, watching your cholesterol and blood pressure protects not only your heart, but other organ systems as well—your kidneys, liver, pancreas, eyes, and peripheral vascular system.”