{"id":11908,"date":"2025-03-10T18:34:26","date_gmt":"2025-03-10T18:34:26","guid":{"rendered":"https:\/\/site.itshrt.com\/worldnews\/why-older-people-may-not-need-to-watch-blood-sugar-so-closely\/"},"modified":"2025-03-10T18:34:26","modified_gmt":"2025-03-10T18:34:26","slug":"why-older-people-may-not-need-to-watch-blood-sugar-so-closely","status":"publish","type":"post","link":"https:\/\/site.itshrt.com\/worldnews\/why-older-people-may-not-need-to-watch-blood-sugar-so-closely\/","title":{"rendered":"Why Older People May Not Need to Watch Blood Sugar So Closely"},"content":{"rendered":"<p> <script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<\/p>\n<div data-testid=\"companionColumn-0\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">By now, Ora Larson recognizes what\u2019s happening. \u201cIt feels like you\u2019re shaking inside,\u201d she said. \u201cI\u2019m speeded up. I\u2019m anxious.\u201d If someone asks whether she would like a salad for lunch, she doesn\u2019t know how to respond.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">She has had several such episodes this year, and they seem to be coming more frequently.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cShe stares and gets a gray color and then she gets confused,\u201d her daughter, Susan Larson, 61, said. \u201cIt\u2019s really scary.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Hypoglycemia occurs when levels of blood sugar, or glucose, fall too low; a reading below 70 milligrams per deciliter is an accepted definition. It can afflict anyone using glucose-lowering medications to control the condition.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">But it occurs more frequently at advanced ages. \u201cIf you\u2019ve been a diabetic for years, it\u2019s likely you\u2019ve experienced an episode,\u201d said Dr. Sei Lee, a geriatrician at the University of California, San Francisco, who researches diabetes in older adults.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-1\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">The elder Ms. Larson, 85, has had Type 2 diabetes for decades. Now her endocrinologist and her primary care doctor worry that hypoglycemia may cause falls, broken bones, heart arrhythmias and cognitive damage.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Both have advised her to let her hemoglobin A1c, a measure of average blood glucose over several months, rise past 7 percent. \u201cThey say, \u2018Don\u2019t worry too much about the highs \u2014 we want to prevent the lows,\u2019\u201d the younger Ms. Larson said.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">But her mother has spent 35 years working to maintain an A1c below 7 percent \u2014 a common recommendation, the goal people sing and dance about in pharma commercials.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">She faithfully injects her prescribed drug, Victoza, about three times a week and watches her diet. She\u2019s the oldest member of the Aqua for Arthritis class at a local pool in St. Paul, Minn.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">So when her doctors recommended a higher A1c, she resisted. \u201cI think it\u2019s a bunch of hooey,\u201d she said. \u201cIt didn\u2019t make sense to me.\u201d<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-2\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">\u201cShe got a lot of encouragement and recognition from her physicians for controlling her diabetes, staying on top of it,\u201d her daughter explained. \u201cThey always praised her \u2018tight control.\u2019\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cFor someone who\u2019s been so compliant all these years, it\u2019s like they changed the rules.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">In fact, they have.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">More than a decade ago, the <a class=\"css-yywogo\" href=\"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.12514\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">American Geriatrics Society called for a hemoglobin A1c of 7.5 to 8 for most older adults<\/a> with diabetes, and 8 to 9 percent for those contending with multiple chronic illnesses and limited life expectancy. (The elder Ms. Larson has multiple sclerosis and hypertension.)<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Other medical societies and advocacy groups, including the <a class=\"css-yywogo\" href=\"https:\/\/diabetesjournals.org\/care\/article\/48\/Supplement_1\/S128\/157561\/6-Glycemic-Goals-and-Hypoglycemia-Standards-of\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">American Diabetes Association<\/a> and the <a class=\"css-yywogo\" href=\"https:\/\/academic.oup.com\/jcem\/article\/104\/5\/1520\/5413486\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">Endocrine Society<\/a>, have also revised their guidelines upward for older patients.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Relaxing aggressive treatment can involve stopping a drug, lowering a dose or switching to another medication \u2014 an approach called de-intensification.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-3\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">The advent of effective new diabetes drugs \u2014 GLP-1 receptor agonists (like Ozempic) and SGLT2 inhibitors (like Jardiance) \u2014 has further altered the landscape. Some patients can substitute these safer medications for risky older ones.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">But the new drugs can also complicate decisions, because not all older patients can switch \u2014 and for those who can, insurance companies may balk at the new medications\u2019 high price tags and deny coverage.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">So de-intensification is proceeding, but <a class=\"css-yywogo\" href=\"https:\/\/www.thelancet.com\/journals\/lanam\/article\/PIIS2667-193X(23)00215-6\/fulltext\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">too gradually<\/a>.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">A 2021 <a class=\"css-yywogo\" href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2785666\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">study of Medicare beneficiaries with diabetes<\/a>, for instance, looked at patients who had gone to an emergency room or been hospitalized because of hypoglycemia. Fewer than half had their medication regimens de-intensified within 100 days.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201c<a class=\"css-yywogo\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35318647\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">Nursing-home residents<\/a> are the ones that get into trouble,\u201d said Dr. Joseph Ouslander, a geriatrician at Florida Atlantic University and the editor in chief of The Journal of the American Geriatrics Society.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Another 2021 <a class=\"css-yywogo\" href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2777044\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">study, of Ontario nursing homes<\/a>, found that over half of residents taking drugs for Type 2 diabetes had A1c levels below 7 percent. Those with the greatest cognitive impairment were being treated most aggressively.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-4\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Dr. Ouslander has calculated, based on <a class=\"css-yywogo\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24615164\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">a national study<\/a>, that roughly 40,000 emergency room visits annually resulted from overtreatment of diabetes in older adults from 2007 to 2011. He <a class=\"css-yywogo\" href=\"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.19201\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">thinks the numbers are likely to be much higher now<\/a>.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">A brief primer: Diabetes can cause such grievous complications \u2014 heart attacks, stroke, vision and hearing loss, chronic kidney disease, amputations \u2014 that so-called strict glycemic control makes sense in young adulthood and middle age.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">But tight control, like every medical treatment, involves a period of time before paying off in improved health. With diabetes, it\u2019s a long time, probably eight to 10 years.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Older people already contending with a variety of health problems may not live long enough to benefit from tight control any longer. \u201cIt was really important when you were 50,\u201d said Dr. Lee. \u201cNow, it\u2019s less important.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Older diabetics don\u2019t always welcome this news. \u201cI thought they\u2019d be happy,\u201d Dr. Lee said, but they push back. \u201cIt\u2019s almost like I\u2019m trying to take something away from them,\u201d he added.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-5\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">The risk that tight control will also set off hypoglycemia increases as patients age.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">It can make people sweaty, panicky, fatigued. When hypoglycemia is severe, \u201cpeople can lose consciousness,\u201d said Dr. Scott Pilla, an internist and diabetes researcher at Johns Hopkins. \u201cThey can become confused. If they\u2019re driving, they could have an accident.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Even milder hypoglycemic events \u201ccan become a qualify-of-life issue if they\u2019re happening frequently,\u201d <a class=\"css-yywogo\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10169988\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">causing anxiety<\/a> in patients and possibly leading them to limit their activities, he added.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Experts point to two kinds of older drugs particularly implicated in hypoglycemia: insulin and <a class=\"css-yywogo\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK513225\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">sulfonylureas<\/a> like glyburide, glipizide and glimepiride.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">For people with Type 1 diabetes, whose bodies cannot produce insulin, injections of the hormone remain essential. But the medication is \u201cwidely recognized as a dangerous drug\u201d because of its hypoglycemia risk and should be carefully monitored, Dr. Lee said.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">The sulfonylureas, he added, \u201care becoming less and less used\u201d because, while less risky than insulin, they also cause hypoglycemia.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-6\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">The great majority of older adults with diabetes have Type 2, which gives them more options. They can supplement the commonly prescribed drug metformin with the newer GLP-1 and SGLT2 drugs, which also have cardiac and kidney benefits. If necessary, they can add insulin to their regimens.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Among the new drugs\u2019 more popular consequences, however, is weight loss.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cFor older people, if they\u2019re frail and not very active, we don\u2019t want them losing weight,\u201d Dr. Pilla pointed out. And both metformin and the GLP-1 and SGLT-2 medications can have gastrointestinal or genitourinary side effects.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">For 15 years, Dan Marsh, 69, an accountant in Media, Pa., has treated his Type 2 diabetes by injecting two forms of insulin daily. When he takes too much, he said, he wakes up at night with \u201cthe damn lows,\u201d and needs to eat and take glucose tablets.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Yet his A1c remains high, and last year doctors amputated part of a toe. Because he takes many other medications for a variety of conditions, he and his doctor have decided not to try different diabetes drugs.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cI know there\u2019s other stuff, but we haven\u2019t gone that way,\u201d Mr. Marsh said.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">With all the new options, including continuous glucose monitors, \u201cfiguring out the optimal treatment is becoming more and more difficult,\u201d Dr. Pilla said.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-7\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Bottom line, though, \u201colder people overestimate the benefit of blood-sugar lowering and underestimate the risk of their medications,\u201d he said. Often, <a class=\"css-yywogo\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36800554\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">their doctors haven\u2019t explained how the trade-offs shift with older age<\/a> and accumulating health problems.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Ora Larson, who carries chewable glucose tablets with her in case of hypoglycemia (fruit juice and candy bars are also popular antidotes), intends to talk over her diabetes treatment with her doctors.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">It\u2019s a good idea. \u201cThe biggest risk factor for severe hypoglycemia is having had hypoglycemia before,\u201d Dr. Lee said.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cIf you have one episode, it should be thought of as a warning signal. It\u2019s incumbent on your doctor to figure out, Why did this happen? What can we do so your blood sugar doesn\u2019t go dangerously low?\u201d<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<p><script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<br \/><a href=\"https:\/\/www.nytimes.com\/2025\/03\/10\/health\/diabetes-blood-sugar-age.html\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By now, Ora Larson recognizes what\u2019s happening. \u201cIt feels like you\u2019re shaking inside,\u201d she said. \u201cI\u2019m speeded up. I\u2019m anxious.\u201d<\/p>\n","protected":false},"author":1,"featured_media":11909,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[36],"tags":[2504,2505,929,1416,1412,136,3936,1069,3937],"class_list":["post-11908","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-2","tag-age","tag-chronological","tag-diabetes","tag-elder-care","tag-elderly","tag-glp-1-ras-drug","tag-hypoglycemia","tag-insulin","tag-longevity"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Why Older People May Not Need to Watch Blood Sugar So Closely - World News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/site.itshrt.com\/worldnews\/why-older-people-may-not-need-to-watch-blood-sugar-so-closely\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why Older People May Not Need to Watch Blood Sugar So Closely - World News\" \/>\n<meta property=\"og:description\" content=\"By now, Ora Larson recognizes what\u2019s happening. \u201cIt feels like you\u2019re shaking inside,\u201d she said. \u201cI\u2019m speeded up. 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