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Healthy Aging With Diabetes

by Robert S. Dinsmoor

“I can tell you one thing — growing old ain’t for wimps!”
—gray-haired gentleman at Sterling Center YMCA in Beverly, Massachusetts

It used to be said that having diabetes aged people an additional 20 years. Today, thanks to better tools for managing diabetes and preventing and treating its complications, people with diabetes have the opportunity to live longer than ever before. However, managing diabetes in the golden years presents a variety of challenges, ranging from increased insulin resistance to being on multiple drugs. Here is what you should know about the effects of diabetes on aging and vice versa, and what you can do to stay healthy and full of vitality well into old age.

What happens during aging
As you age, you may be most aware of your new gray hairs and wrinkles, but aging causes changes throughout the entire body. A person’s basal metabolic rate — the amount of energy the body expends at rest — declines with age. By some estimates, a person’s basal metabolism drops by 2% per decade starting at age 20. Some researchers believe that this decline is due almost solely to the loss of muscle mass that comes with age.

The body’s ability to process oxygen — its aerobic capacity — also declines with age. By some estimates, a person’s aerobic capacity by age 65 is typically only 60% to 70% of what it was when he was younger (although the decline appears to be less in older people who exercise regularly). This decline may be due to several factors, including poor lung function, heart function, and blood circulation.

With advancing years, the body gradually becomes less adept at taking up and using glucose from the bloodstream — a condition known as glucose intolerance, which sets the stage for Type 2 diabetes. One contributing factor to glucose intolerance is a condition known as insulin resistance, in which people’s body tissues become less and less sensitive to insulin. This may be due to having too much body fat, which interferes with the muscles’ ability to use insulin.

The mineral content of bones also declines with age, leaving older people with weaker, more brittle bones. This may be related to poor nutrition, deficient calcium absorption, inactivity, and, in women, hormonal changes after menopause. Brittle bones set the stage for osteoporosis (a condition of having abnormally porous bones) and fractures, which can be devastating for older people.

The cartilage around joints tends to break down and wear away over time, causing pain, swelling, and loss of motion of the joints. In fact, about half of people age 65 or older have x-ray evidence of osteoarthritis in at least one joint.

In the United States, where people tend to eat too much of the wrong foods and exercise too little, blood pressure tends to rise with age. Poor diet, inactivity, weight gain, and a slower metabolic rate all set the stage for circulatory problems and cardiovascular disease.

Meanwhile, people’s visual acuity diminishes. They have difficulty seeing things up close and adjusting to changes in the level of light. People’s hearing may become affected as well, as they lose the ability to hear sounds in the upper frequencies or to hear distinct sounds when there is a lot of background noise. Sense of taste may be affected as well. Certain cognitive abilities, such as spatial ability, reasoning, complex problem solving, and working memory, all tend to decline somewhat with age.

How diabetes contributes to aging
Diabetes and its complications can contribute to or mimic the aging process in a number of ways. There is some evidence that high blood glucose itself can contribute to aging. Glucose in the blood binds to proteins throughout the body through a process called nonenzymatic glycation. As glucose and protein interact chemically, they produce a number of metabolic by-products, including advanced glycosylation endproducts (AGEs). Unlike other metabolic by-products, AGEs do not break down; instead, they accumulate throughout the body.

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