The statistics are alarming: One in four people age 65 and older have either type 1 or type 2 diabetes, compared to one in 10 for those younger than 65, according to the American Diabetes Association. In addition, half of older adults have prediabetes, a condition that features higher-than-normal blood glucose levels. Prediabetes can lead to type 2 diabetes unless a lifestyle and diet change is adopted to slow the onset or prevent the disease entirely.

Even more frightening—most people are unaware they have the disease until its effects become serious.

Diabetes in Older Adults

According to Lindsay Johnson, a Registered and Licensed Dietitian and the Clinical Dietitian at Barnes-Jewish Extended Care, a skilled nursing community in Clayton, MO, senior adults are particularly susceptible to the effects of diabetes.

“Many factors associated with aging, such as depression, cognitive challenges, financial difficulties, multiple illnesses, and the loss of a spouse, can undermine a senior adult’s ability and willingness to deal with her or his diabetes,” Lindsay says.

If unchecked, diabetes has a host of serious complications:

• Increased risk for infections and injuries
• Accelerated muscle loss
• Damaged kidneys
• Increased risk for Alzheimer’s disease
• Increased risk for heart attack or stroke
• Vision loss
• Persistent pain
• Nerve damage
• Limb amputation

Diet is key to controlling diabetes but, as an added challenge, older adults frequently suffer from a loss of appetite as their ability to taste and smell diminishes. In addition, their energy and activity levels drop, and depression may become a factor.

Tips for Managing Diabetes

1. Controlling Carbohydrates

A person with type 1 diabetes cannot produce insulin (also called insulin-dependent diabetes). “It’s very important for people with type 1 diabetes to coordinate the amount of carbohydrates they consume in conjunction with their insulin injections,” Lindsay says. With type 2 diabetes, the body produces insulin, but the cells resist taking it in (insulin-resistant). Type 2 diabetes often require just a diet and lifestyle change, including exercise and weight loss. Other cases may require oral medications or insulin, and sometimes all of these in combination must be practiced to address the disease.

Carbohydrate control is key to controlling both types of diabetes, as the body turns carbohydrates into glucose, making blood sugar levels rise.

Eating a diet lower in carbohydrates featuring lean protein (beans, poultry, fish), and whole grain foods slow the release of sugar into the bloodstream. Lindsay cautions, however, that people should still consume at least 135 grams of carbohydrates per day, depending on a person’s size and activity levels. Most people trying to lose weight feel best eating 45g of carbohydrates at each meal, three meals per day. If they are more active, often a daily snack around 3 p.m. with 15-20g of carbohydrates (for example: low-fat fruited yogurt with ¼ cup almonds) will keep the metabolism fueled and prevent excessive snacking later in the day.

2. Understanding Fats

According to Lindsay, some people mistakenly try to eliminate fat from their diet. She says some fats are necessary like those found in avocados, nuts, and olives, and that trans fats and saturated fats are the ones to avoid.

“A diet filled with fat-free items can lead to low blood sugar (called hypoglycemia) or feeling hungry between meals,” Lindsay says. “In addition, if the label says ‘fat-free,’ often sugar, salt and/or artificial sweeteners have been added.”

3. What Not to Consume

Sugary drinks, juice, sweet tea, lemonade, and excessive amounts of milk (Lindsay recommends 1-2 cups of low-fat milk per day) are high on her list of what not to consume. She also advocates eliminating or reducing alcohol consumption, limiting salt intake, avoiding packaged or processed food, and reducing cholesterol intake to 200 mg per day.

4. The Good Stuff

The key to managing diabetes is making sure you fill your plate with more nutritious foods. Try these:

• Lean protein: low-fat dairy, skinless fish and poultry (or a smaller portion with skin of 3-4 oz.), and leaner cuts of beef.
• Good carbohydrates: whole-grain foods, legumes such as lentils, peas, beans, and sweet potatoes.
• Fiber: fruits, legumes, oatmeal, vegetables, and whole grains.
• Good fats: avocados, nuts/nut butters, olives, butter, and canola oil (good for higher heat cooking).
• Fruits and vegetables: Think green: vegetables such as broccoli, spinach, asparagus, Brussels sprouts, and leafy greens. Also, think colors of the rainbow: fruits include tomatoes, grapes, apples, oranges, and cherries.

5. Manage Diabetes by Educating Yourself

If you suspect that you might have diabetes, get tested. According to the American Diabetes Association, symptoms include:

• Frequent urination
• Feeling very thirsty
• Feeling hungry—even though you have eaten
• Extreme fatigue
• Blurry vision
• Cuts/bruises that are slow to heal
• Tingling, pain, or numbness in the hands/feet

Diabetes control is a balancing act that requires education. For example, Lindsay says everyone who has diabetes should know the symptoms of hypoglycemia. They include sweating, fatigue, dizziness, paleness, or blurred vision, and can result in loss of consciousness or coma. Glucose tablets or snacks (Lindsay suggests foods with 15 grams of carbohydrates) should be taken, and glucose levels should be monitored every 15 minutes until they return to normal.

People with diabetes should know how to use a glucometer and what an A1C test reveals about how well they have managed their diabetes over a period of months.

If you have diabetes and are struggling to control it, Lindsay suggests asking your primary care physician for a referral to a registered dietitian and/or a certified diabetes educator for help. Diabetes is not a disease that can be ignored or taken lightly.

A Final Thought on Food

“Teach yourself that food, first and foremost, is fuel,” Lindsay says. “It’s also a pleasure. For example, I recommend fruit with a meal to meet carb requirements, but maybe a couple of times a week you could substitute a small dessert for the fruit.” Her point is that, within limits, you can practice flexibility in your food choices that will allow you to indulge yourself from time to time.

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