On February 13, Seniors Today hosted its weekly Health Live webinar with leading Endocrinology and Diabetic Consultant Dr Phulrenu Chauhan speaking on Diabetes Care for Senior Citizens. Dr Noor Gill captured takeaways from the session.
Dr Phulrenu Chauhan is a leading Endocrinology and Diabetic Consultant based in Mumbai. She is Section Coordinator, Department of Endocrinology at the PD Hinduja Hospital and Research Centre, Mahim, Mumbai and Head of Department, Department of Endocrinology at Hinduja Healthcare Surgical, Khar, Mumbai. A DM in Endocrinology and an MD in General Medicine from the GS Medical College and KEM Hospital where she also did her MBBS, Dr Chauhan is a Member of the Maharashtra University of Health Sciences studies committee. She is a guide and teacher for postgraduate and various other students. She is also a published author in various Indian and international publications and has been a speaker at a variety of global and national conferences.
Here are the takeaways from Dr Chauhan’s opening remarks and responses to the Q&A with Seniors Today readers.
– Diabetes in senior citizens is a new chapter altogether from when you were diagnosed to be diabetic. In our country, diabetes is recognised at the age of 45-50 years. And if it goes unattended, high blood sugar cause complications and these are recognisable after 10-15 years of diabetes. Once you cross the age line and become senior, if you have diabetes, you are more prone to hypertension, high cholesterol, cardiac conditions and many other complications.
– There are two sets of complications, one is the microvascular complications which involve the eyes, kidneys, and the nerves getting affected. These tend to occur much earlier.
– If you are 60 and have recently been diagnosed with diabetes, though it takes about 10-15 years for the complications to set in and affect the other organs, you run a higher risk of macro vascular complications – a stroke, heart disease or the vessels of the feet get blocked giving rise to diabetic foot, ulcers and infections.
– In diabetes, there are usually no symptoms till the complications appear. There are however certain complications such as an infection, a foot infection, a lung infection- which can occur since diabetic patients are more prone to getting infections. Tuberculosis, fungal infections (especially in women), urinary tract infections are very common due to uncontrolled blood sugar levels.
– Triglycerides are fats that are produced by the liver. Very often, high sugar levels and triglycerides go hand in hand. Once the blood sugar levels are high, the triglycerides start building up in the liver and are continuously released. Those who have long-standing diabetes and have no insulin in their body, which invariably happens after many years of living with the metabolic disorder, they have triglyceride levels that slowly start going up and cause complications.
Everyone has heard of cholesterol, but very often triglycerides are not looked at/ neglected. Triglycerides cause immediate fat release and that can cause fatty liver, the fat can accumulate in the heart and cause heart disease, stroke or can accumulate in the vessels and cause large vessel diseases as a complication of diabetes.
– Omega 3 fatty acids are supposed to be good fatty acids, as compared to triglycerides or cholesterol and are not produced in high amounts by the body. They are easily digestible fatty acids which get dispersed and utilised very easily.
– Normal HbA1c in all individuals is less than 5.7. If your HbA1c is marginally elevated, you are deemed to be pre-diabetic. Not all pre-diabetics become diabetics. This depends on your lifestyle modifications which includes-
– Regular exercise
– Watching your diet and weight
– Regular monitoring of blood sugars is a must. Glucometers these days are accurate and are also handy, feasible and easily available.
Food and exercise are the two main cornerstones of diabetes management.
– Patients who are in the pre-diabetic stage should get their HbA1c done every six months and to maintain the levels below 6.5 at all times.
– The safe levels for blood sugar after the age of 65, for fasting blood sugar levels between the range of 140-150mg/dl is acceptable and a post meal (post prandial) blood sugar level around 200 mg/dl is admissible and advocated. HbA1c of 7 or 7.5 is what we are looking to maintain after the age of 65 and 8- 8.5 after the age of 75 years.
– As the age rises, the renal function also decreases. So, as the age progresses, the creatinine levels also rise. But we don’t just look at the creatinine level, we also look at other factors such as the urea levels and the GFR (glomerular filtration rate). If the GRF is falling from, say, 50-60 to 20-30; then we are worried. To maintain your creatinine levels, you need to not just keep your blood sugar levels under control but also take care of your blood pressure and the amount of protein intake in your diet.
– Diabetes mellitus is a lifestyle disorder. Except for Type 1 diabetes where you need insulin for life, Type 2 can be controlled though not cured only with lifestyle modifications.
– As the age progresses, we are not just worried about hyperglycemia due to diabetes but are also worried about hypoglycaemia in case your blood sugar falls drastically. Hypoglycemia is more serious and worrisome than hyperglycemia, because it can precipitate a heart attack, it can lead to coma, convulsions.