Type 2 diabetes in older people: how to get the medication right
What changes in type 2 diabetes treatment with age, which mistakes are most common and how to organise doses at home.
In short
- In older people, avoiding hypoglycaemia (low blood sugar) is as important as lowering blood sugar.
- Glycated haemoglobin (HbA1c) targets are individualised: stricter in healthy older people and more flexible in frail people.
- Insulin and sulfonylureas are the diabetes medicines with the highest risk of hypoglycaemia.
- Taking each medicine on time and in relation to meals, as the doctor indicates, is the basis of good treatment adherence.
To get type 2 diabetes medication right in an older person there are three things to do: take each medicine at the time and in the way prescribed, keep meals regular, and review the treatment with the doctor whenever health, weight or kidney function changes. The big risk to avoid is hypoglycaemia, which in older people can go unnoticed and lead to falls.
We explain what Spanish scientific societies say and how to organise day to day life at home.
| What will you find in this article? |
What changes in diabetes treatment with age?
With age the priority changes: rather than achieving very low figures, the aim is to preserve independence and quality of life and avoid side effects, especially hypoglycaemia. This is set out in the consensus document from several Spanish scientific societies on type 2 diabetes in people over 75 or who are frail.
That consensus proposes adapting the HbA1c target to each person's situation:
| The person's situation | Guideline HbA1c target |
|---|---|
| Healthy older person, with good physical and cognitive function | 7 to 7.5% |
| Frail older person, with dependency, dementia or limited life expectancy | 7.5 to 8.5% |
| Palliative care | Avoid symptoms of high or low sugar; HbA1c is no longer relevant |
The specific target is always set by the doctor after a full assessment.
Why is hypoglycaemia such a concern?
Hypoglycaemia is a blood sugar level below 70 mg/dl, according to MedlinePlus. In older people it is particularly dangerous because warning symptoms may be unclear or absent, and it can lead to falls, confusion or hospital admissions.
- Common symptoms: sweating, shaking, hunger, palpitations, irritability, blurred vision or confusion.
- The Spanish consensus notes that hypoglycaemia caused by diabetes medicines (insulin and sulfonylureas) is the second most common cause of emergency admissions due to medicine side effects.
- Some medicines, such as metformin or DPP-4 inhibitors, carry a low risk of hypoglycaemia; others, such as SGLT2 inhibitors, can encourage genital infections and dehydration in older people.
If a hypo occurs, follow the plan your healthcare team has given you and always tell the doctor, because it may mean the treatment needs adjusting.
What are the most common medication mistakes?
The most common mistakes relate to timing and meals: taking the diabetes medicine and then not eating, doubling up after a missed dose, or changing the regimen without advice. All of them increase the risk of hypoglycaemia or poor control.
- Taking the medicine without eating afterwards, when the doctor has prescribed it with meals.
- Making up for a missed dose by taking two together.
- Stopping treatment because blood sugar is fine.
- Not telling the doctor about vomiting, diarrhoea or eating very little for several days.
- Mixing up two insulins or two similar looking tablets.
If you are unsure what to do about a missed dose, check the leaflet or ask the pharmacist. There are more tips in how to follow any dosage without mistakes.
How should you organise doses at home?
What works best is a fixed routine: the same mealtimes, medication prepared by day and time of day, and a simple record of doses and blood sugar readings if the doctor has asked for one. That makes it easy to see if something has been missed.
- Keep the medication near where meals are eaten, if the dose goes with food.
- Keep a list of all medicines to hand, including those for blood pressure or cholesterol.
- Ask the doctor for a review if there is weight loss, falls, memory changes or a blood test showing poorer kidney function.
- Check possible interactions with the pharmacist whenever a new medicine is added.
A practical example: Rosa, 79, and the meals she skipped
Let us take the case of Rosa, 79, who has type 2 diabetes, high blood pressure and osteoarthritis and takes 7 medicines. Lately she eats little at breakfast and on some mornings has felt dizzy after her breakfast tablet.
- Her son writes it down and books an appointment with the GP, who reviews the regimen bearing in mind her age and her risk of falls.
- The doctor adjusts the treatment and explains what to do if she feels unwell again.
- At home, the medication is organised by day and time of day, and Rosa takes the tablet only once she is already eating breakfast.
- Once a week, her son checks that no doses are left over.
How can IMA Health help?
When diabetes is added to other treatments, it is easy to make mistakes. IMA Health coordinates with a specialised pharmacy that prepares medication by day and time of each dose, delivers it to the home and provides personalised follow-up, so that doses arrive in order and any change in the regimen is reflected in time. If high blood pressure is also involved, you may be interested in our article on hypertension.
Sources
- Gómez-Huelgas R, et al. Consensus on type 2 diabetes treatment in older people (SEMI, SED, SEGG and others). Revista Clínica Española, 2018
- MedlinePlus: hypoglycaemia (Spanish)
This article is for information only and does not replace advice from your doctor or pharmacist.