Diabetes in the Older Adult

Older adults may develop diabetes after decades of gradually increasing insulin resistance, reduced beta-cell insulin secretion, or both. The same age-related changes also weaken counter-regulatory responses—the hormonal “rescue system” that normally raises glucose when it falls. A medication dose, missed meal, or reduced kidney function can therefore produce a larger and more prolonged glucose drop than expected. Hypoglycaemia may not announce itself with tremor, sweating, and palpitations. An older adult may instead become quiet, unsteady, confused, irritable, weak, or suddenly less able to manage familiar tasks. A fall before breakfast, a new episode of “confusion,” or unexplained daytime sleepiness should prompt a glucose check before it is attributed to dementia, stroke, or normal aging. Hyperglycaemia can also present subtly. Polyuria, thirst, fatigue, blurred vision, recurrent infections, weight loss, dehydration, or a decline in function may be the first clues. Reduced thirst sensation, limited mobility, cognitive impairment, and medications such as diuretics can make dehydration develop quickly.