Diabetes in the Older Adult

Diabetes in later life is often less dramatic than students expect. A person may not report thirst, blurred vision, or shaking. Instead, the first clue may be a fall, new confusion, missed meals, an unexplained decline in function, or a family member saying, “They have not seemed like themselves.” Several physiologic changes create this pattern. Beta-cell function declines with age, so insulin release is less effective. Insulin resistance also rises, especially with inactivity, increased adiposity, or acute illness. These changes promote hyperglycemia. At the same time, the body may give a weaker warning response when glucose falls. Counter-regulatory hormones that normally trigger tremor, palpitations, hunger, and sweating may respond less strongly. An older adult can therefore become confused, unsteady, or profoundly weak before recognizing that glucose is low. Reduced kidney function, inconsistent food intake, cognitive impairment, polypharmacy, and medication errors amplify the risk. The same glucose-lowering dose that was tolerated last month may become unsafe after poor oral intake, diarrhea, weight loss, or declining renal function.