Frailty/BS levels in the elderly

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• posted by Michael Rolls
  on 4 Oct 2017 at 06:13

  

  Research by Dr. Toshihiko Yanase of Fukuoka University Japan, referred to in an article in ‘Diabetes Self Management’ by David Spero, BSN, RN, suggests that low HbA1c levels in elderly – over 65 – people is associated with higher levels of frailty than those with higher levels. The study covered 132 people who had had T2 diabetes for an average of 17 years.
  The same article also cites the American Diabetes Association recommending looser control for people who are more frail. In these official guidelines they recommend an A1C target of 7.5% for healthy people over 65 compared to 7.0% for younger people. For people with other illnesses or impairments their goal is 8.0% and for complex patients in poor health the A1C goal is 8.5%
  Later in the article Spero quotes a meta-analysis by Mike Lustgarten, PhD, finding that whilst a BMI of 20-25 is associated with the longest life expectancy for younger people, for those over 65 the optimum level is around 27.5
  https://www.diabetesselfmanagement.com/blog/elderly-a1c-targets-older-people-relaxed-glucose-goals/
  An article in the Daily Telegraph of 2/10/17 by James Le Fanu, who writes the paper’s regular ‘Surgery’ column, comments that blood sugar naturally rises with age and that for those over 70 who do have diabetes the optimum HbA1c level is 8-9 rather than the treatment target of 7.5, leading to over-treatment and increased risk of hypoglycaemia among the elderly.

  All of the above leaves me wondering. At 80 years of age and having worked at my diet and exercise to get my weight down from 14-2 to 12-7 and my HbA1c down from 75 to 40 since January, I do wonder if in fact I have done more than I need have. Certainly these articles do make me question the ‘one size fits all’ approach to HbA1c and BMI levels that I have seen in the past from my health centre.
  Mike

• posted by dumptynomore
  on 4 Oct 2017 at 11:53

  

  Hi Michael – Thanks for highlighting that.That’s practically to what I said on the 19th August under ‘renew refocus’ post – copied and pasted as follows –

  ‘The NHS don’t always want you to aim for low levels. This is because there is a section of the community who are at risk of hypos, e.g. the elderly, people with complicated pathologies. When people are given a reading to aim for , sometimes they bend over backwards, go against what is desirable for them and then end up with hypos. Or simply not being able to meet those low figures and giving up altogether, or ending up with depression and anxiety because they feel a failure for not being able to get thet low number. As I said 48-58 is an ACCEPTABLE NHS figure(not my figure) for a general guideline. Each person should be assessed individually. Of course aiming for less than 48, for those whose personal medical history allows it is good and desirable.’

  Take note Jenni from the block!

• posted by sunshine-girl
  on 4 Oct 2017 at 11:56

  

  Hi Michael, this has always been the case for older patients but it is the old question of chicken or egg. Maybe the frailty comes from having had diabetes for 17 years would have damaged the muscles and connective tissue as well as, I have just found out, collagen making people look older but that is besides the point. In my opinion I think one of the real reasons for wanting older people to remain on the higher end of the scale is because it is more dangerous for an 80 / 85 years old to have a hypo or keep good control due to forgetfulness, not eating properly etc, than the danger of getting some of the side effect of high blood sugar. If an older person gets heart problems, well it almost to be expected same with kidney or sight problems. Therefore it is the balance between hypoglycaemia and other related problems that come with hyperglycaemia. But it doesn’t have to be like that.

  You dont sound like an old doddery person and if you are sprightly (but I hate that word) and of good mental awareness then keeping your HbA1c within ‘normal’ levels can only be a good thing. Keep up with the diet and the exercise is good for all ages.

• posted by Michael Rolls
  on 4 Oct 2017 at 12:35

  

  Thanks for the responses, Maddeningly enough I had a collapse on the 23rd and have been fitted with a pacemaker and given strict instructions not to resume my normal exercise regime (20 minutes on a treadmill, 20 minutes floor exercises, Monday-Friday) for at least 6 weeks and then only to restart gradually.
  I do appreciate the ‘chicken and egg’ possibility on that Japanese study and having worked so hard to lose weight as well as reduce my BS levels, I am very loath to let my weight go up again. Apart from anything else, at teh beginning of 2016 when I was around the 15 stone mark I found 10-12 minutes on the treadmill as much as I could reasonably manage, whereas until the collapse 20 minutes was comfortable.
  Mike

• posted by KrysiaD
  on 4 Oct 2017 at 13:24

  

  Michael – so sorry to hear of your collapse. Hopefully, your rehab goes really well. Your good hba1c and weight loss can only help.

  Sunshine-girl ! I totally agree with absolutely everything you said in your post.

• posted by Michael Rolls
  on 4 Oct 2017 at 15:53

  

  Thank you
  Mike

• posted by dumptynomore
  on 4 Oct 2017 at 17:29

  

  Hi Mike – so sorry to hear of your recent collapse. I have no doubt your successes have minimized the effects of the event so you are to be congratulated on that. A clear indication that you should continue with your health goals when you are well enough to do so. Wishing you a speedy recovery.

• posted by Michael Rolls
  on 5 Oct 2017 at 02:33

  

  Thanks everybody
  Mike

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