Gerontologic Considerations of Diabetes Mellitus
According to the Department of Health and Human Services (2011), 18.5 % of the United States population is over the age of 60 years. Of these, 10.9 million (26.9%) are diagnosed with diabetes mellitus (ADA, 2011.) In Lewis and associates’ text book on Medical- Surgical nursing, Lewis states that the incidence of diabetes mellitus (DM) increases with age (Lewis, Dirksen, Heitkemper, Bucher, and Camera, 2011.) The purpose of this paper is to explore the disease process of diabetes mellitus in the geriatric population.
According to Lewis and associates, DM is a chronic disease that affects multiple body systems. For the purpose of this paper, only DM type 2 will be discussed based on the assumption that a majority of patients aged 60 years or older have this type. The primary defects of this disease consist of insulin resistance, decreased insulin production, inappropriate glucose production by the liver, and alterations in production of adipokines. Insulin resistance is the result of defects in the body’s insulin receptors. This finding predates all cases of DM type 2 and the development of impaired glucose tolerance. In insulin resistance, beta cells in the pancreas are stimulated to increase insulin production to compensate for the lack of response by the insulin receptors. Gradually, the beta cells begin to fail to secrete enough insulin to meet the body’s demands resulting in hyperglycemia. As a result of increased glucose in the liver, the liver begins to malfunction and release glucose at inappropriate times, thereby worsening hyperglycemia. Adding to the problem, glucose and fat metabolism is altered in adipose tissue, which is generally abundant in those with DM type 2. (Lewis et al., 2011)
In addition to these defects of DM, the normal process of aging is associated with additional risks for the older adult. These risks include a decline in pancreas beta cell function, diminished insulin sensitivity, altered carbohydrate metabolism, and taking medications that effect normal insulin action. (Lewis et al., 2011) According to a study published in Diabetes this year, the cause of age related pancreatic β-cells replication decline is not only related to the genetic expression of p16/INK4A mRNA but also multifactoral systemic involvement. The study was inconclusive on the factors involved, but the researchers suggest more studies need to be completed. (Salpeter, Khalaileh, Weinberg-Corem, Ziv, Glaser, and Dor, 2013) Another study suggests that diminished insulin sensitivity in the elderly is multifactoral as well. (Chen, Bergman, Pacini, Porte, Jr., 1985) Factors contributing to altered carbohydrate metabolism in aging include obesity and a progressive decline in physical activity. (Lewis et al., 2011) Lastly, the elderly also may take medications that treat comorbidities that effect insulin and glucose. Some of these include coreg, lipitor, corticosteroids, and lotensin....