High Blood Sugars:  Why Are “Sticky” Highs Difficult to Treat as We Age?

Managing hyperglycemia (high blood sugar) becomes more challenging for individuals with Type 1 diabetes (T1D) as they age due to changes in insulin sensitivity, physical activity levels, and other health factors.

Why It’s More Difficult to Treat Hyperglycemia with Age

1. Decreased Insulin Sensitivity: Aging can reduce how effectively cells respond to insulin, leading to higher blood sugar levels despite appropriate dosing. Chronic inflammation and hormonal changes may exacerbate insulin resistance.
2. Slower Absorption of Insulin: Peripheral circulation often declines with age, which can delay the absorption of subcutaneous insulin, prolonging high blood sugar episodes.
3. Comorbidities: Age-related conditions like kidney disease or heart disease can complicate insulin management and exacerbate hyperglycemia.
4. Polypharmacy: The use of multiple medications for other health issues can interact with diabetes treatments, potentially increasing glucose levels.
5. Reduced Physical Activity: Lower activity levels in older adults can decrease the body’s ability to utilize glucose efficiently, contributing to stubborn hyperglycemia.

Strategies for Managing Stubborn Hyperglycemia

• Adjusting Insulin Regimens:
  • Use faster-acting insulins, such as Lispro or Aspart, which can help correct blood sugar more quickly.
  • Inhaled insulin (e.g., Afrezza) may offer rapid correction in some cases, particularly for those with delayed subcutaneous absorption.
• Technology Integration:
  • Continuous glucose monitors (CGMs) provide real-time data, helping to identify patterns of persistent hyperglycemia and allowing for more precise insulin dosing.
  • Automated insulin delivery systems can adjust basal rates dynamically based on glucose trends.
• Improving Insulin Sensitivity:
  • Light to moderate exercise, if safe and feasible, can enhance glucose uptake.
  • Diet modifications, such as reducing high-glycemic-index foods, can prevent prolonged elevations in glucose levels.
  • If tolerated and prescribed by your medical physician, medications such as Metformin, GLP-1s, and SGLT-2s can help improve insulin sensitivity.
• Personalized Care:
  • Frequent consultation with a healthcare provider is crucial to adjust insulin doses, meal timing, and other aspects of the treatment plan.
  • Assessment for conditions like gastroparesis, which can delay glucose absorption and insulin action, is important.
• Addressing Stress and Hormonal Factors:
  • Stress management strategies can mitigate cortisol-related blood sugar spikes.
  • Monitoring for the “dawn phenomenon” (early morning glucose rise) may guide adjustments to evening insulin dosing.

These approaches aim to minimize risks associated with high blood sugar while maintaining quality of life in older individuals with T1D.

Hypoglycemia:  Symptoms and Treatments CHANGE as We Age with T1D

Hypoglycemia in individuals with Type 1 Diabetes (T1D) can become increasingly complex as we age due to changes in physiology, medication use, and overall health. Here’s a breakdown of the symptoms, therapies, and considerations associated with hypoglycemia in older adults with T1D, as well as why it takes longer to correct low blood sugar in this population.

Changes in Symptoms of Hypoglycemia with Age

Therapeutic Challenges and Considerations

1. Delayed Absorption of Glucose
   • Older adults often have slower gastric emptying, which can delay the absorption of glucose or other carbohydrates consumed to treat a low blood sugar episode.
2. Impaired Liver Function
   • The liver’s ability to release stored glucose (glycogen) in response to hypoglycemia may diminish with age, reducing the body’s ability to self-correct.
3. Comorbidities and Polypharmacy
   • Conditions like kidney disease, heart disease, or neuropathy can affect blood sugar levels and complicate treatment.
   • Medications such as beta-blockers can blunt hypoglycemia symptoms, making detection harder.
4. Insulin Sensitivity Changes
   • Decreased physical activity and changes in body composition can lead to insulin resistance or sensitivity, affecting how blood sugar is managed.

Longer Recovery Time for Hypoglycemia in Older Adults

1. Slower Metabolism
   • Aging slows down metabolic processes, which can lengthen the time it takes for ingested carbohydrates to raise blood sugar levels.
2. Limited Glycogen Reserves
   • Older individuals may have reduced glycogen stores in the liver due to aging or poor nutrition, hindering the body’s ability to respond quickly to low blood sugar.
3. Reduced Counterregulatory Hormonal Response
   • Aging and prolonged diabetes reduce the secretion of hormones like glucagon and epinephrine, which are critical for raising blood sugar.
4. Delayed Reaction Times
   • Older adults may take longer to act on low blood sugar symptoms, further extending recovery time.

Management Strategies for Older T1D Patients

1. Frequent Monitoring
   • Continuous glucose monitors (CGMs) can provide real-time alerts for low blood sugar, helping prevent severe hypoglycemia. Simplified Treatment Protocols
   • Pre-measured glucose tablets or gels can ensure proper and efficient correction of low blood sugar without guesswork.
2. Individualized Targets
   • Less stringent blood sugar targets may be appropriate to reduce the risk of hypoglycemia in older adults. For example, it can be helpful to raise the Low Alert level on your CGM to 80 or 85, rather than lower levels you might have used in the past, such as 70, so that you can get ahead of a rapidly dropping glucose level.
3. Education and Support
   • Regular training for patients and caregivers about recognizing and managing hypoglycemia is essential.
4. Dietary Adjustments
   • Consistent carbohydrate intake, particularly around exercise and bedtime, can help stabilize blood sugar levels.

Conclusion

As people with T1D age, the management of hypoglycemia requires greater vigilance and a tailored approach to account for physiological changes and comorbidities. Slower glucose absorption, reduced hormonal responses, and cognitive challenges are key reasons why it takes longer to correct hypoglycemia in older adults. By adapting therapies and incorporating supportive tools like CGMs, the risks of hypoglycemia can be minimized, ensuring a better quality of life for aging individuals with T1D.

Last updated 2025-08-20.