Age-related changes in glucose tolerance are characterized by the following trends.
After 50 years for each subsequent 10 years:
• fasting glycemia increases by 0.055 mmol / l (1 mg%);
• glycemia 2 hours after a meal increases by 0.5 mmol / L (10 mg%).
Diagnosis of type 2 diabetes in old age
• Diagnostic LEDs criteria in the elderly do not differ from when nyatyh WHO (1999) for the entire population as a whole (see. “Diagnostic Crete Ria SD”).
• Persons aged> 65 years should be screened for active reveal Lenie diabetes: fasting plasma glucose measurement and blood glucose 2 hours after a meal or a glucose tolerance test.
Features of type 2 diabetes in the elderly Clinical features:
» Asymptomatic course (absence of specific complaints of dry mouth, thirst, polyuria, etc.);
• the prevalence of nonspecific complaints (weakness, impaired memory, etc.);
• clinical picture of micro- and microangiopathies in the “debut” of diabetes;
• combined multiple organ pathology.
Laboratory Features:
• absence of fasting hyperglycemia in 60% of patients;
• the prevalence of isolated postprandial hyperglycemia in 50-70% of patients;
• increasing the renal threshold for glucose with age (for glycosuria is at glycemia> 12-13 mmol / l).
Psychosocial features:
• social exclusion;
• low material capabilities;
• violation of cognitive functions (decreased memory, learning ability, etc.).
The goals of treatment of patients with type 2 diabetes in old age depends on the environment its life expectancy of the patient, the safety of Cogne tive functions and the ability to carry out regular self-Gly kemii.
Type 2 diabetes mellitus therapy in old age
• Diet + exercise.
• Oral hypoglycemic drugs.
• Insulin or combination therapy.
Criteria for the optimal commensuration of type 2 diabetes in old age
| Indicators | Life expectancy | |
| More than 10-15 years | Less than 5 years | |
| Fasting Glycemia (mmol / L) | <6.5 | <10 |
| Glycemia 2 hours after eating (mmol / L) | <8.0 | <11-15 |
| HbAlc (%) | <7.0 | <9-10 |
These recommendations are generic and for reference only, and must be indie vidualizirovany for each patient depending on his physical and mental status.
Diet
Dietary requirements do not differ from those of young people. It is necessary to insist on a diet in case of high life expectancy.
Physical exercise
They must be strictly individualized according to the general physics cal condition of the patient and the severity of complications and associated slaughtering timetotal. Walking for 30-60 minutes is recommended. daily or every other day.
Sugar-lowering tablets
Requirements for tablets hypoglycemic agents have pozhi mated patients with type 2 diabetes of type:
• minimal risk of hypoglycemia;
• lack of nephrotoxicity;
• lack of hepatotoxicity;
• lack of cardiotoxicity;
• lack of interaction with other drugs;
• ease of use.
Recommended tablets hypoglycemic agents in pozhi scrap age:
• Glycvidone (Glurenorm);
• Gliclazide (Diabeton, Diabeton MB);
• Repaglinide (Novonorm);
• Nateglinide (Starlix);
• Pioglitazone (Aktos).
Old-age insulin therapy
Recommended modes of insulin therapy (mono – and combination)
| Scheme | Beforebreakfast | Before lunch | Beforedinner | Before bedtime |
| 1 | CM | – | CM | PI |
| 2 | Meglitinide | Meglitinide | Meglitinide | PI |
| 3 | Metformin | – | Metformin | PI |
| 4 | Thiazolidine-dion | – | – | PI |
| 5 | PI | – | – | PI |
| 6 | Mixed 30/70 | – | Mixed 30/70 | – |
| 7 | KI + PI | KI | KI | PI |
SM – sulfonylurea preparations KI – short-acting insulin PI – medium-acting insulin