[Diabetes mellitus in the elderly].
The prevalence of diabetes increase in the elderly. Ageing is one of the most important factors contributing to development of glucose intolerance (insuline resistance). NHANES II data showed that in the poppulation over 65 years 18.7% has got overt diabetes and  22.8% glucose intolerance. Similar data were obtained among ageing inhabitants of the city of Bialystok (downtown). The criteria of diagnosis of  diabetes in the elderly are the same like in the younger population. However, in the elderly the clinical symptoms are not characteristic and scanty (limited). The period without symptoms is long. Very often, the diabetes is diagnosed for the first time in patient with the heart infarct, brain stroke, diabetic foot or even hyperosmolar coma. There may occur two critical situations in the elderly diabetic persons, namely non-ketotic hyperosmolar coma and hypoglycameia. The non-ketotic hyperosmolar coma is a result of a considerable elevation in the blood concentration of glucose, sodium and urea. This, in turn, is a consequence of osmotic diuresis which  is non balanced by elevation in the volume of water intake. Factors facilitating development of  the coma include: nontreated diabetes, infirmity, inadequate care, diuretics, stroke, hyperthermia. Hypoglycaemia in the   elderly is a very serious problem. It can cause arrhythmia, a rise in the blood pressure, unconsciousness, falls and injuries. The most often reason of hypoglycaemia in the elderly are: long-acting derivatives of sulphonylurea, treatment with insulin and irregular meals. The major aims of treatment of diabetes in the elderly are: reduction of  hyperglycaemia, reduction in the development of complications and minimizing of the risk of hypoglycaemia. An elderly patient with diabetes should have each year   a check-up which would include examination of the eyes, kidneys, feet. The elderly patient with diabetes is often crippled, indolent and lives often alone. Therefore, such a patient should be taken care of by a team of people. The most important role in the team should be played by a family physician and a social nurse.
Maria
M
Górska
D000273:Adipose Tissue / Q000502:physiology; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male