Managing type 2 diabetes mellitus in older people 乐龄糖尿病护理 | Jasper Lodge East (Kuantan关丹）

Malaysia boleh! We are officially the most obesed country in South East Asia and this is nothing that we should be proud of. With age, obesity brings about many health issues, particularly in areas of what doctors call metabolic syndrome which includes insulin resistance and type 2 diabetes mellitus. The mainstay of treatment remains a healthy lifestyle which has been shown in a recent study which can totally reverse the diabetic state.

Diet

A healthy diet is for everyone. There  is no such thing as a diabetic diet. Cut back on simple refined sugar and carbohydrate such as white rice, white bread, white flour, cake, sweetened beverage and cookies. No sugar is more superior than another because it is still broken down in the same manner in the body. Follow the Suku Suku Separuh principle and fill your plate with a quarter of carbohydrate, a quarter of lean meat/fish/chicken, half with fruits and vegetables. Snack on nuts such as cashew, almond, sunflower seeds instead of sweet pastries. Read here to get how certain ingredients can be swapped in popular recipes for a healthier alternative. The occasional indulgence is fine as long as it's in moderation. 

Exercise

I have previously written how much and how frequently exercise should be done here. It should include both endurance/aerobic and resistance training. For weight loss,  aerobic exercises such as jogging, swimming and zumba are the way to go. A modest weight loss of 5-10% over 6 months is more than adequate. Cutting down the waistline also directly reduce the amount of visceral fat (fat around important organs) which predict the risk of having a heart attack. Even if your BMI is ideal, exercise can improve fitness, prevent frailty and reduce fall risk. 

Oral medication

For an older person, the treatment regime should be simple. The target for sugar control is individualised and more lenient for those who are frail, who has limited life expectancy or who already has multiple other illnesses such as kidney failure and heart disease as these patients may have significant complications from having low blood sugar. Certain oral medications has dose adjustments for those who have kidney failure. Some cannot be used at all if the kidney disease reaches certain severity. Most oral medications can reduce the Hba1c by about 1.

Injectables

For those whose Hba1c remains uncontrolled or when oral medications are not suitable, insulin injections may be necessary. There are multiple ways in which insulin injections can be combined with or without oral medications to achieve a good level of sugar control. Insulin is nevertheless the most effective medications in treating diabetes but it comes with the side effect of weight gain and low blood sugar. There is another new injectable medications called the GLP1-RA which acts to achieve weight loss and is great for those who has kidney and heart problems. 

Want to know how to manage your diabetes well? Talk to one of the healthcare professionals at Jasper Lodge now to get an individualised plan for your diabetes. If you have no time to prepare a healthy meal and do not know how much exercise is enough, head on to one of our centres to try our daycare service. We have dedicated nurses to monitor your food intake, monitor sugar and physiotherapist to teach you how to exercise correctly. Jasper Lodge East is coming to Kuantan soon as well. 

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