Kitabchi AE, Umpierrez GE, Miles JM, Pophlations JN. Early symptoms include the following:. Mayo Clinic Alumni Association.

DKA in elderly populations -

The use of rosiglitazone is now highly restricted. The class has traditionally been expensive, although the approval of generic pioglitazone may reduce its cost.

Dipeptidyl peptidase-4 inhibitors are useful for postprandial hyperglycemia, impart little risk for hypoglycemia, and are well tolerated, suggesting potential benefits for older patients. However, their high cost may be limiting.

Glucagon-like peptide-1 agonists also target postprandial hyperglycemia and impart low risk of hypoglycemia, but their associated nausea and weight loss may be problematic in frail older patients.

Injection therapy may add to regimen complexity, and its very high cost may be problematic. For some agents, dose reduction is required for renal dysfunction.

Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients.

However, given the heterogeneity of the older adult population, the risk of hypoglycemia must be carefully considered before using an insulin regimen to achieve an aggressive target for hyperglycemia control. The addition of long-acting insulin was similarly effective in achieving A1C goals for older patients with type 2 diabetes mean age 69 years in a series of trials with no greater rates of hypoglycemia than in younger patients mean age 53 years Problems with vision or manual dexterity may be barriers to insulin therapy for some older adults.

Pen devices improve ease of use but are more costly than the use of vials and syringes. Hypoglycemia risk especially nocturnal is somewhat lower with analog compared with human insulins, but the former are more expensive.

Insulin-induced weight gain is a concern for some patients, and the need for more blood glucose monitoring may increase treatment burden. Other approved therapies for which there is little evidence in older patients include colesevelam, bromocriptine, and pramlintide.

An emerging drug class, sodium-glucose cotransporter-2 inhibitors, may require additional study in older adults to assess whether drug-associated genital infections or urinary incontinence is problematic in this population. Age appears to affect counter-regulatory responses to hypoglycemia in nondiabetic individuals.

Studies in older individuals with diabetes are limited. One small study compared responses to hypoglycemic clamps in older mean age 70 years versus middle-aged mean age 51 years people with type 2 diabetes.

Hormonal counter-regulatory responses to hypoglycemia did not differ between age-groups, but middle-aged participants had a significant increase in autonomic and neuroglycopenic symptoms at the end of the hypoglycemic period, while older participants did not.

Half of the middle-aged participants, but only 1 out of 13 older participants, correctly reported that their blood glucose was low during hypoglycemia In a population analysis of Medicaid enrollees treated with insulin or sulfonylureas, the incidence of serious hypoglycemia defined as that leading to emergency department visit, hospitalization, or death was approximately 2 per person-years , but clearly studies based on administrative databases miss less catastrophic hypoglycemia.

The risk factors for hypoglycemia in diabetes in general use of insulin or insulin secretagogues, duration of diabetes, antecedent hypoglycemia, erratic meals, exercise, renal insufficiency presumably apply to older patients as well. In the Medicaid study cited above, independent risk factors included hospital discharge within the prior 30 days, advanced age, black race, and use of five or more concomitant medications Assessment of risk factors for hypoglycemia is an important part of the clinical care of older adults with hypoglycemia.

Education of both patient and caregiver on the prevention, detection, and treatment of hypoglycemia is paramount. Although attention has rightly been paid to the risks of overtreatment of hyperglycemia in older adults hypoglycemia, treatment burden, possibly increased mortality , untreated or undertreated hyperglycemia also has risks, even in patients with life expectancy too short to be impacted by the development of chronic complications.

Hyperglycemic hyperosmolar syndrome is a particularly severe complication of unrecognized or undertreated hyperglycemia in older adults. Although it is appropriate to relax glycemic targets for older patients with a history of hypoglycemia, a high burden of comorbidities, and limited life expectancy, goals that minimize severe hyperglycemia are indicated for almost all patients.

A central concept in geriatric diabetes care guidelines is that providers should base decisions regarding treatment targets or interventions on life expectancy 2 , 17 , 56 , Patients whose life expectancy is limited e. An observation supporting this concept is that cumulative event curves for the intensive and conventional glycemic control arms of the UKPDS separated after the 9-year mark.

National Vital Statistics life table estimates of average life expectancy for adults of specific ages, sexes, and races may not apply to older adults with diabetes, who have shorter life expectancies than the average older adult. Mortality prediction models that account for variables such as comorbidities and functional status can serve as the basis for making more refined life expectancy estimates — Mortality prediction models specific to diabetes exist but were not designed to inform treatment decisions , A limitation of existing mortality models is that they can help to rank patients by probability of death, but these probabilities must still be transformed into a life expectancy for a particular older diabetic patient.

Simulation models can help transform mortality prediction into a usable life expectancy. One such model estimated the benefits of lowering A1C from 8. A combination of multiple comorbid illnesses and functional impairments was a better predictor of limited life expectancy and diminished benefits of intensive glucose control than age alone.

This model suggests that life expectancy averages less than 5 years for patients aged 60—64 years with seven additional index points points due to comorbid conditions and functional impairments , aged 65—69 years with six additional points, aged 70—74 years with five additional points, and aged 75—79 years with four additional points.

An example of comorbid illnesses is the diagnosis of cancer, which confers two points, whereas an example of a functional impairment is the inability to bathe oneself, conferring two points.

In light of the paucity of data for diabetes care in older adults, treatment decisions are frequently made with considerable uncertainty. Shared decision making has been advocated as an approach to improving the quality of these so-called preference-sensitive medical decisions , Key components of the shared decision-making approach are 1 establishing an ongoing partnership between patient and provider, 2 information exchange, 3 deliberation on choices, and 4 deciding and acting on decisions When asked about their health care goals, older diabetic patients focus most on their functional status and independence A key component of improving communication in the clinical setting may be finding congruence between patient goals and the biomedical goals on which clinicians tend to focus.

Thus, providers must first educate patients and their caregivers about what is known about the role of risk factors in the development of complications and then discuss the possible harms and benefits of interventions to reduce these risk factors.

Equally important is discussing the actual medications that may be needed to achieve treatment goals because patients may have strong preferences about the treatment regimen.

In a study of patient preferences regarding diabetes complications and treatments, end-stage complications had the greatest perceived burden on quality of life; however, comprehensive diabetes treatments had significant negative perceived quality-of-life effects, similar to those of intermediate complications Preferences for each health state varied widely among patients, and this variation was not related to health status , implying that the preferences of an individual patient cannot be assumed to be known based on health status.

Many older adults rely on family members or friends to help them with their treatment decisions or to implement day-to-day treatments. In the case of the older person with cognitive deficits, the family member or friend may in fact be serving as a surrogate decision maker.

Among older adults, African Americans and Hispanics have higher incidence and prevalence of type 2 diabetes than non-Hispanic whites, and those with diagnosed diabetes have worse glycemic control and higher rates of comorbid conditions and complications The Institute of Medicine found that although health care access and demographic variables account for some racial and ethnic disparities, there are persistent, residual gaps in outcomes attributed to differences in the quality of care received There is clearly a need for more research into the disparities in diabetes, particularly to understand the full impact of quality improvement programs and culturally tailored interventions among vulnerable older adults with diabetes.

Long-term care LTC facilities include nursing homes, which provide h nursing care for patients in either residential care or rehabilitative care, and adult family homes where the level of care is not as acute.

LTC residents with diabetes have more falls , higher rates of CVD and depression, more functional impairment, and more cognitive decline and dependency than residents without diabetes The LTC facility resident may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.

Therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition. Vulnerable older adults, particularly those with cognitive dysfunction, may have impaired thirst sensation, contributing to the risk of volume depletion and hyperglycemic crises.

Precipitating situations include illness, institutional settings LTC or hospital , aversion to drinking water, dysphasia requiring thickened liquids, and some medications Fluid intake should be encouraged and monitored in an institutional setting. A major issue in LTC facilities is frequent staff turnover with resultant unfamiliarity with vulnerable residents There is often inadequate oversight of glycemic control related to infrequent review of glycemic trends, complex and difficult-to-read glucose logs, and lack of specific diabetes treatment algorithms including glycemic parameters for provider notification Excessive reliance on sliding-scale insulin SSI has been documented.

Evidence-based policies for glycemic control, use of insulin, and treatment of hypoglycemia have the potential to improve the care of residents with diabetes, alleviate some of the burden caused by frequent staff turnover, and even lead to more staff satisfaction.

Older adults are more apt to require hospitalization than younger adults, and those with diabetes are at very high risk of requiring hospitalization.

There is a dearth of studies addressing older adults with diabetes, particularly more frail older adults, in the hospital. Many guidelines that apply to hospitalized adults with hyperglycemia can probably be extrapolated to older adults , Less stringent glycemic targets may be appropriate for patients with multiple comorbidities and reduced life expectancy—criteria that could be applicable to many hospitalized older adults.

Studies of glycemic control targets in critically ill patients did include older adults, and therefore the recommendations for insulin infusions and glycemic goals of the ADA 17 are reasonable for older adults in intensive care units.

Other recommendations for all adults, such as avoiding the use of sliding scale—only regimens and noninsulin antihyperglycemic drugs, are also reasonable for hospitalized older adults.

Transitions from hospital to home or to short- or long-term care facilities are times of risk for patients with diabetes, and probably more so for older patients.

Older patients on insulin may need to increase or decrease their dose as they recuperate from their acute illness and their diet improves. Delirium acute decline in cognitive function is a common complication seen in older adults during and after hospitalization and may require more supervision to avoid errors in dosing.

Medication reconciliation, patient and caregiver education, and close communication between inpatient and outpatient care teams, are critically important to ensure patient safety and reduce readmission rates.

After review of the available evidence and consideration of issues that might influence treatment decisions in older adults with diabetes, the authors have developed recommendations in a number of areas. Table 1 provides a framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia.

This framework is based on the work of Blaum et al. The three classes correspond with increasing levels of mortality risk The observation that there are three major classes of older diabetic patients is supported by other research The framework is an attempt to balance the expected time frame of benefit of interventions with anticipated life expectancy.

Table 2 provides additional consensus recommendations beyond goals of treatment of glycemia, blood pressure, and dyslipidemia. A framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes.

The exclusion of older, and especially frail older, participants from most traditional randomized controlled trials of diabetes interventions has left us with large gaps in our knowledge of how best to address diabetes in the age-group with the highest prevalence rates.

Future research should allow and account for the complexity and heterogeneity of older adults. Studies will need to include patients with multiple comorbidities, dependent living situations, and geriatric syndromes in order to advance our knowledge about these populations.

Suggested research questions and topics are listed in Table 3. The ADA thanks the following individuals for their excellent presentations at the Consensus Development Conference on Diabetes and Older Adults: Edward Gregg, PhD; Nicolas Musi, MD; M. Miller, PhD; R. Harsha Rao, MD, FRCP; Craig Williams, PharmD, BCPS, FNLA; Barbara Resnick, PhD, CRNP, FAAN, FAANP; Carol M.

Mangione, MD, MSPH; Jill P. Crandall, MD; Caroline S. Blaum, MD, MS; Jeff D. Williamson, MD, MHS; John M. Jakicic, PhD; Tamara Harris, MD, MS; and Naushira Pandya, MD, CMD. The authors thank Bobbie Alexander, Monique Lindsy, and Earnestine Walker for their assistance with the consensus development conference.

The consensus development conference was supported by a planning grant from the Association of Subspecialty Professors though a grant from the John A. Hartford Foundation , by educational grants from Lilly USA, LLC and Novo Nordisk, and sponsorships from the Medco Foundation and Sanofi.

Sponsors had no influence on the selection of speakers or writing group members, topics and content presented at the conference, or the content of this report.

Pepper Older Americans Independence Center P30 AG receives speaking honoraria from Sanofi. chairs a Data Monitoring Committee for Takeda Global Research and Development for studies of a new dipeptidyl peptidase-4 inhibitor. receives grant support from Sanofi and has served as a consultant to Regeneron.

receives grant support from Sanofi. No other potential conflicts of interest relevant to this article were reported. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care.

Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 35, Issue Previous Article Next Article. What is the epidemiology and pathogenesis of diabetes in older adults? What current guidelines exist for treating diabetes in older adults?

What issues need to be considered in individualizing treatment recommendations for older adults? What are consensus recommendations for clinicians treating older adults with or at risk for diabetes? How can gaps in the evidence best be filled? Article Navigation. Consensus Report November 14 Diabetes in Older Adults M.

Sue Kirkman, MD ; M. Sue Kirkman, MD. From 1 Medical Affairs and Community Information, American Diabetes Association, Alexandria, Virginia; the. Corresponding author: M. Sue Kirkman, skirkman diabetes. This Site. Google Scholar. Vanessa Jones Briscoe, PHD, NP, CDE ; Vanessa Jones Briscoe, PHD, NP, CDE.

Nathaniel Clark, MD, MS, RD ; Nathaniel Clark, MD, MS, RD. Hermes Florez, MD, MPH, PHD ; Hermes Florez, MD, MPH, PHD. Linda B. Haas, PHC, RN, CDE ; Linda B. Haas, PHC, RN, CDE. Jeffrey B.

Halter, MD ; Jeffrey B. Halter, MD. Elbert S. Huang, MD, MPH ; Elbert S. Huang, MD, MPH. Mary T. Korytkowski, MD ; Mary T. Korytkowski, MD. Medha N. Munshi, MD ; Medha N. Munshi, MD. Peggy Soule Odegard, BS, PHARMD, CDE ; Peggy Soule Odegard, BS, PHARMD, CDE.

Richard E. Pratley, MD ; Richard E. Pratley, MD. Carrie S. Swift, MS, RD, BC-ADM, CDE Carrie S. Swift, MS, RD, BC-ADM, CDE. Diabetes Care ;35 12 — Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. What are consensus recommendations for treating older adults with or at risk for diabetes?

Table 1 A framework for considering treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes. View large.

View Large. Table 2 Additional consensus recommendations for care of older adults with diabetes. Table 3 Consensus recommendations for research questions about diabetes in older adults. disclosed no conflicts of interest.

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention.

Effect of aging on glucose homeostasis: accelerated deterioration of beta-cell function in individuals with impaired glucose tolerance. Search ADS. Full accounting of diabetes and pre-diabetes in the U. population in and Projection of the year burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence.

Impact of recent increase in incidence on future diabetes burden: U. Declining rates of hospitalization for nontraumatic lower-extremity amputation in the diabetic population aged 40 years or older: U. Diabetes Public Health Resource. Available from www.

Accessed 27 September Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Aging correlates with decreased beta-cell proliferative capacity and enhanced sensitivity to apoptosis: a potential role for Fas and pancreatic duodenal homeobox American Diabetes Association.

The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes. Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program. Impact of lifestyle intervention and metformin on health-related quality of life: the Diabetes Prevention Program randomized trial.

Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. UK Prospective Diabetes Study UKPDS Group.

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study.

Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Glucose control and vascular complications in veterans with type 2 diabetes. The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial.

Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association.

Long-term multiple risk factor interventions in Japanese elderly diabetic patients: the Japanese Elderly Diabetes Intervention Trial—study design, baseline characteristics and effects of intervention. Survival as a function of HbA 1c in people with type 2 diabetes: a retrospective cohort study.

Glycemic control, complications, and death in older diabetic patients: the Diabetes and Aging Study. Comorbidity affects the relationship between glycemic control and cardiovascular outcomes in diabetes: a cohort study.

Pravastatin in elderly individuals at risk of vascular disease PROSPER : a randomised controlled trial. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, participants in 14 randomised trials of statins.

Effects of long-term fenofibrate therapy on cardiovascular events in people with type 2 diabetes mellitus the FIELD study : randomised controlled trial. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment HOT randomised trial.

Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. Blood pressure and cardiovascular disease risk in the Veterans Affairs Diabetes Trial.

Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes JPAD Trial Investigators.

Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications.

De Berardis. Association of aspirin use with major bleeding in patients with and without diabetes. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Adopting 3-year screening intervals for sight-threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy.

Department of Veterans Affairs. European Diabetes Working Party for Older People clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes and the risk of multi-system aging phenotypes: a systematic review and meta-analysis.

Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes ACCORD MIND : a randomised open-label substudy.

Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus.

Gait analysis in a challenging environment differentiates between fallers and nonfallers among older patients with peripheral neuropathy. An exploration of step time variability on smooth and irregular surfaces in older persons with neuropathy.

Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Older women with diabetes have a higher risk of falls: a prospective study. The American Geriatrics Society.

Early and intensive therapy for management of hyperglycemia and cardiovascular risk factors in patients with type 2 diabetes. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the Diabetes and Aging Study.

Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Relationship of depression and diabetes self-care, medication adherence, and preventive care.

Association of depression with increased risk of dementia in patients with type 2 diabetes: the Diabetes and Aging Study. The association of comorbid depression with mortality in patients with type 2 diabetes.

Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, to Risk factors for hearing impairment among U. adults with diabetes: National Health and Nutrition Examination Survey J Clin Epidemiol.

Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Zhao M. Causes of hospitalization among Type II diabetes patients [in Chinese]. Causes Modern Med. Google Scholar. Chen X, Yu Y. Analysis of Admission Causes among Diabetic Patients in West China Hospital from to [in Chinese].

Chinese J Evid Based Med. Lin W. Causes of hospitalization among Type II diabetes patients. Dissertation [in Chinese].

Hangzhou: Zhejiang University; Assal J, Groop L. Definition, diagnosis and classification of diabetes mellitus and its complications. Association AD. Diabetic nephropathy. Article Google Scholar.

Chiniwala N, Jabbour S. Management of diabetes mellitus in the elderly. Curr Opin Endocrinol Diabetes Obes. Rauseo A, Pacilli A, Palena A, De Cosmo SA. Management of type 2 diabetes in geriatric patients. J Nephrol. PubMed Google Scholar.

Wu CH, Chen CY, Wu YC, Weng LJ, Baai-Shyun H. Diabetes mellitus and functional impairment in Taiwanese older men and women. Arch Gerontol Geriatr. Diamond-Stanic MK, You YH, Sharma K. Sugar, sex, and TGF-beta in diabetic nephropathy.

Semin Nephrol. Article CAS PubMed PubMed Central Google Scholar. Hadjadj S, Gourdy P, Gallois Y, Leroux S, Halimi J, Dardari D, Guilloteau G, Saulnier P, Roussel R, Dupuis O. Serum estradiol was associated with diabetic nephropathy.

Moulineaux: Journal de Neuroradiologie; Araki A, Ito H. Diabetes mellitus and geriatric syndromes.

Geriatr Gerontol Int. Munshi M, Grande L, Hayes M, Ayres D, Suhl E, Capelson R, Lin S, Milberg W, Weinger K. Cognitive dysfunction is associated with poor diabetes control in older adults. Article PubMed PubMed Central Google Scholar.

Kalyani RR, Saudek CD, Brancati FL, Selvin E. Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey NHANES , — Munshi MN, Maguchi M, Segal AR.

Treatment of type 2 diabetes in the elderly. Curr Diab Rep. Abbatecola AM, Paolisso G. Diabetes care targets in older persons. Diabetes Res Clin Pract. Morley JE. Diabetes and aging: epidemiologic overview. Clin Geriatr Med. Rosenstock J. Management of type 2 diabetes mellitus in the elderly: special considerations.

Drugs Aging. Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. Malazy OT, Shariat M, Heshmat R, Majlesi F, Alimohammadian M, Tabari NK, Larijani B.

Vulvovaginal candidiasis and its related factors in diabetic women. Taiwan J Obstet Gynecol. Faraji R, Rahimi MA, Rezvanmadani F, Hashemi M. Prevalence of vaginal candidiasis infection in diabetic women.

Afr J Microbiol Res. Lin TL, Chen GD, Chen YC, Huang CN, Ng SC. Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes. Ehrlich SF, Quesenberry CP, Van Den Eeden SK, Shan J, Ferrara A. Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer.

Kornum JB, Thomsen RW, Riis A, Lervang HH, Schonheyder HC, Sorensen HT. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case—control study. Falagas ME, Mourtzoukou EG, Vardakas KZ.

Sex differences in the incidence and severity of respiratory tract infections. Respir Med. Bouman A, Schipper M, Heineman MJ, Faas MM. Am J Reprod Immun. Gleeson M, Bishop N, Oliveira M, McCauley T, Tauler P. Sex differences in immune variables and respiratory infection incidence in an athletic population.

Exerc Immunol Rev. Hirji I, Guo Z, Andersson SW, Hammar N, Gomez-Caminero A. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database GPRD. J Diabetes Complications. Gomez-Caminero A, Hirji I, Andersson S, Hammar N. Risk Factors Associated with the Incidence of Urinary Tract Infections among Patients with Type 2 Diabetes in a Community Practice Setting in the UK.

In: Pharmacoepidemiology And Drug Safety. Malden: Wiley-Blackwell Commerce Place; Matthews SJ, Lancaster JW. Urinary tract infections in the elderly population. Am J Geriatr Pharmacother. Peleg AY, Weerarathna T, McCarthy JS, Davis TM. Common infections in diabetes: pathogenesis, management and relationship to glycaemic control.

Diabetes Metab Res Rev. Thewjitcharoen Y, Sunthornyothin S. Clinical characteristics of diabetic ketoacidosis in newly diagnosed adult patients. Wolfson EM, DeKalb A, Rojhani A. Women's health in the 21st century. Int J Gynaecol Obstet. Barski L, Harman-Boehm I, Nevzorov R, Rabaev E, Zektser M, Jotkowitz AB, Zeller L, Shleyfer E, Almog Y.

Gender-related differences in clinical characteristics and outcomes in patients with diabetic ketoacidosis. Gend Med. Download references. Our study was supported by The Natural Science Foundation of Zhejiang Province LQ13H , and by The Science and Technology Program of Wenzhou Municipality Y In attempt to preserve the privacy of the patients, the clinical data of the patients will not be shared; the data can be available from authors upon request.

LW: performed the data analyses and wrote the manuscript; CC and GH: contributed significantly to analysis and manuscript preparation; DXH: helped perform the analysis with constructive discussions. LJJ: contributed significantly to analysis and manuscript preparation.

All authors read and approved the final manuscript. The study was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University, China.

Written consent was obtained. Department of Geriatrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Science and Technology Information Center, Wenzhou Medical University Library, Wenzhou, China.

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

You can also search for this author in PubMed Google Scholar. Correspondence to Junjian Li. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions.

Lin, W. et al. Hospitalization of elderly diabetic patients: characteristics, reasons for admission, and gender differences. BMC Geriatr 16 , Download citation. Received : 14 January Accepted : 27 August Published : 05 September Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Understanding the differences in characteristics, gender, and common causes for admission in hospitalized elderly diabetic patients provides a theoretical basis for their successful management.

Results The most frequent reasons stated for admission were related to the chronic complications of diabetes Conclusion The most frequent reasons for hospital admission in elderly diabetic patients were chronic complications of diabetes, hyperglycemia, and infection. Background Diabetes mellitus is a worldwide epidemic whose prevalence is increasing rapidly.

Data collection The reasons for hospitalization were collected based on the chief complaints of the patients and the main diagnosis at hospital discharge. Statistical analysis Data management and analysis were conducted using SPSS for Windows Result General characteristics of patients During the 3-year study period, elderly diabetic patients, women Table 1 Clinical characteristics of elderly diabetic patients a Full size table.

Table 2 Common reasons for admission of elderly diabetics by gender a Full size table. Table 3 Hospital admissions attributable to infection analyzed by gender a Full size table. Discussion In this study, the most frequent reasons for hospital admission in elderly diabetic patients were the chronic complications of diabetes, hyperglycemia, and infection.

Conclusion This retrospective study highlighted some of the characteristics of hospitalized elderly diabetic patients and the gender differences in causes of hospital admission.

Abbreviations HbA1c: Hemoglobin A1c SPSS: Statistical package for the social sciences. References Cheng TO. Article PubMed Google Scholar Wild S, Roglic G, Green A, Sicree R, King H. Article PubMed Google Scholar Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, et al.

Article CAS PubMed Google Scholar Cheng TO. Article PubMed Google Scholar Xu L, Xie X, Wang S, Wang Y, Jonas JB. Article CAS PubMed Google Scholar Sloan FA, Bethel MA, Ruiz D, Shea AH, Feinglos MN. Article PubMed Google Scholar Bethel MA, Sloan FA, Belsky D, Feinglos MN. Article PubMed Google Scholar Bo S, Ciccone G, Grassi G, Gancia R, Rosato R, Merletti F, Pagano GF.

Article PubMed Google Scholar Jiang HJ, Stryer D, Friedman B, Andrews R. Article PubMed Google Scholar Zhao M.

Google Scholar Chen X, Yu Y. Google Scholar Lin W. Google Scholar Association AD. Article Google Scholar Chiniwala N, Jabbour S. Article PubMed Google Scholar Rauseo A, Pacilli A, Palena A, De Cosmo SA.

PubMed Google Scholar Wu CH, Chen CY, Wu YC, Weng LJ, Baai-Shyun H. Article PubMed Google Scholar Diamond-Stanic MK, You YH, Sharma K.

Copyright © Korean Elderyl Society. Populationd DKA in elderly populations Site. Search Close. Epderly Share Facebook Twitter Google LinkedIn Metrics Metabolic rate measurement Article J Korean Geriatr Soc. Published online June 30, The clinical characteristics of older adults with DKA have not been well characterized. To characterize the elderly patients with DKA, we described how DKA in the elderly differs from that in the young adults.

Video

Management of Diabetic Ketoacidosis (DKA) - Lecturio

DKA in elderly populations -

Therefore, metformin should be used with caution in older patients. Older patients treated with metformin should be cautioned to stop taking the drug immediately if they become seriously ill for any reason or if they are to undergo a procedure requiring the use of iodinated contrast material.

In addition, kidney function measurement of serum creatinine and eGFR should be monitored every three to six months rather than annually. See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Contraindications'.

This approach is reviewed in detail separately. See "Initial management of hyperglycemia in adults with type 2 diabetes mellitus", section on 'Contraindications to or intolerance of metformin' and "Initial management of hyperglycemia in adults with type 2 diabetes mellitus", section on 'Established cardiovascular or kidney disease' and "Management of hyperglycemia in patients with type 2 diabetes and advanced chronic kidney disease or end-stage kidney disease".

Evaluation — If glycemic goals are not met with a single agent, older patients should be evaluated for contributing causes similar to younger adults, such as difficulty adhering to the medication, side effects, or adherence to the nutrition plan [ 1,6 ].

If hyperglycemia above the individualized target persists, an additional agent is needed. In older patients who require more than one agent, pill-dosing dispensers may help improve adherence.

As an alternative, family members or caregivers may be required to help administer medication. Additional nutritional counseling and diabetes self-management education and support programs, when available, should be offered to patients.

Choice of second drug — For older patients who have persistent hyperglycemia above their individualized glycemic target despite treatment with lifestyle intervention and metformin , a second agent should be selected.

The choice of a second agent should be individualized based upon efficacy, the patient's underlying comorbidities, risk of hypoglycemia, impact on body weight, side effects, and cost figure 1. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Indications for a second agent' and "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Our approach'.

The individual agents are discussed in more detail in the individual topic reviews. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus" and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus" and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus" and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus" and "Thiazolidinediones in the treatment of type 2 diabetes mellitus" and "Alpha-glucosidase inhibitors for treatment of diabetes mellitus".

Insulin is sometimes underutilized in older adults because of fear by the clinician, patient, or family that it is too complicated or dangerous. Addition of once-daily basal insulin to a non-insulin agent usually metformin is a low-complexity regimen with a relatively lower risk of hypoglycemia compared with regimens using multiple daily insulin doses [ 44 ].

Before beginning insulin therapy, it is important to evaluate whether the patient is physically and cognitively capable of using an insulin pen or drawing up and injecting the appropriate dose of insulin using syringes and vials , monitoring blood glucose, and recognizing and treating hypoglycemia.

For older patients taking a fixed daily dose of insulin who are capable of injecting insulin but not of drawing it into the syringe, a pharmacist or family member may prepare a week's supply of insulin in syringes and leave them in the refrigerator.

Such a plan may allow an older patient to remain living independently at home. Insulin pens, when available and affordable, are an alternative for patients who have difficulty administering insulin using vials and syringes due to vision or motor limitations.

Morning administration reduces the risk of nocturnal hypoglycemia, and fasting hyperglycemia is less of a concern in older patients [ 45 ]. See "Management of hyperglycemia in patients with type 2 diabetes and advanced chronic kidney disease or end-stage kidney disease", section on 'Treatment'.

Insulin therapy is discussed in detail elsewhere. See "General principles of insulin therapy in diabetes mellitus" and "Insulin therapy in type 2 diabetes mellitus". History of cardiovascular or kidney disease — Sodium-glucose co-transporter 2 SGLT2 inhibitors empagliflozin or canagliflozin or glucagon-like peptide 1 GLP-1 receptor agonists liraglutide or semaglutide are reasonable second agents for patients with established cardiovascular or kidney disease [ 46,47 ].

All of these drugs confer low risk of hypoglycemia on their own or in combination with other drugs that do not usually cause hypoglycemia. GLP-1 receptor agonists should be titrated slowly, with monitoring for gastrointestinal GI side effects, which could precipitate dehydration and acute kidney injury AKI.

We avoid use of SGLT2 inhibitors in patients with frequent bacterial urinary tract infections or genitourinary yeast infections, low bone density and high risk for falls and fractures, foot ulceration, and factors predisposing to diabetic ketoacidosis eg, pancreatic insufficiency, drug or alcohol abuse disorder because of increased risk while using these agents.

See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects'. Avoidance of hypoglycemia — In older adults at increased risk of hypoglycemia, GLP-1 receptor agonists, SGLT2 inhibitors, and dipeptidyl peptidase 4 DPP-4 inhibitors are options as they are associated with a low hypoglycemia risk.

DPP-4 inhibitors are useful only to improve mild hyperglycemia since they are relatively weak agents and usually lower A1C levels by only 0. However, in frail older adults with late-onset diabetes, particularly patients at high risk of hypoglycemia and impaired awareness of hypoglycemia, a DPP-4 inhibitor can be a useful agent to lower glycemia to the individualized target.

See "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Glycemic efficacy'. Avoidance of weight gain — GLP-1 receptor agonists may be appropriate to use when avoidance of weight gain is a primary consideration and cost is not a major barrier.

SGLT2 inhibitors are also associated with weight loss. However, in the absence of cardiovascular or kidney disease, the risks of SGLT2 inhibitors in older individuals eg, dehydration, falls, fractures may outweigh the benefits.

DPP-4 inhibitors, which are weight neutral, also may be a reasonable option. Cost concerns — If cost is a concern, adding a short- or intermediate-acting sulfonylurea with a relatively lower rate of hypoglycemia, such as glipizide , glimepiride , or gliclazide gliclazide not available in the United States , remains a reasonable alternative.

Choosing a sulfonylurea balances glucose-lowering efficacy, universal local availability, and low cost with risk of hypoglycemia and weight gain. Short- or intermediate-acting sulfonylureas can also be used cautiously in patients with impaired kidney function when other classes are contraindicated.

Generic pioglitazone is also inexpensive. However, we tend not to use pioglitazone in older adults due to risks of fluid retention, weight gain, heart failure, macular edema, and osteoporotic fracture. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Hypoglycemia' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Safety'.

A typical starting dose of a sulfonylurea is as follows see "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Dosing and monitoring' :. In patients who are using sulfonylureas, the presence and frequency of hypoglycemia should be evaluated at each visit.

All blood glucose monitoring BGM or continuous glucose monitoring CGM data that are available should be reviewed and the frequency and details of any recognized episodes of hypoglycemia determined.

See 'Monitoring of glycemia' below and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Hypoglycemia'.

The reported frequency of sulfonylurea-related hypoglycemia in older adults is variable. In an analysis of adverse event data from a drug surveillance project, oral hypoglycemic agents accounted for 10 percent of hospitalizations for adverse drug events [ 49 ].

Long-acting sulfonylureas eg, glyburide should be avoided in older adults due to higher risk of hypoglycemia, especially in individuals with inconsistent timing or content of their meals or those with cognitive decline that prevents prompt recognition or treatment of hypoglycemic episodes [ 50 ].

Drug-induced hypoglycemia may be a limiting factor for sulfonylurea use in older adults and is most likely to occur in the following circumstances:. These issues may arise when there is a change in overall health status in older adults with diabetes.

Dual agent failure — For patients who do not achieve A1C goals with two agents eg, metformin plus sulfonylurea or another agent , we suggest starting or intensifying insulin therapy see "Insulin therapy in type 2 diabetes mellitus", section on 'Designing an insulin regimen'.

In patients on sulfonylureas and metformin who are starting insulin therapy, sulfonylureas are generally tapered and discontinued, while metformin is continued. Another option is two oral agents and a GLP-1 receptor agonist. It is reasonable to try a GLP-1 agonist before starting insulin in patients who are near glycemic goals, those who prefer to avoid insulin, and those in whom weight loss or avoidance of hypoglycemia is a primary consideration.

A once-weekly GLP-1 agonist formulation is particularly attractive for patients and caregivers. However, this option often increases costs and contributes to the problem of polypharmacy in older adults see 'Polypharmacy and deintensification' below.

The management of persistent hyperglycemia is reviewed in more detail separately. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Dual agent failure'. Polypharmacy and deintensification — Use of multiple drugs is common in older adults.

Management of hyperglycemia and its associated risk factors often increases the number of medications even more in the older adult with diabetes. Side effects may exacerbate comorbidities and impede patients' ability to manage their diabetes.

Therefore, the medication list should be kept current and reviewed at each visit [ 1,6 ]. Overtreatment and complicated regimens should be avoided. Complex regimens that may have been required in the past can often be simplified to be consistent with the modified glycemic targets of an older patient [ 53,54 ].

See 'Controlling hyperglycemia' above. It is important to look for any conditions that interfere with A1C measurement eg, anemia, recent infections, kidney failure, erythropoietin therapy, etc. In these settings or when unexpected or discordant A1C values are encountered, medication adjustments should be based on glucose readings from a glucose meter or continuous glucose monitoring CGM rather than A1C.

See "Measurements of chronic glycemia in diabetes mellitus", section on 'Glycated hemoglobin A1C '. However, infrequent or no BGM may be adequate for older patients with type 2 diabetes who are diet treated or who are treated with oral agents not associated with hypoglycemia.

The effectiveness of BGM in terms of improving glycemic management in patients with type 2 diabetes is less clear than for type 1 diabetes. See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'Type 2 diabetes'.

CGM use also should be considered for older patients with impaired awareness of hypoglycemia, those taking other medications that confer higher risk of hypoglycemia eg, sulfonylureas , and those who have difficulty performing BGM through fingerstick checks due to cognitive or physical limitations.

Advances in CGM have made it possible to use the technology in older and even frail patients. Professional CGM devices, applied like a patch on a patient's arm or abdomen depending on the CGM model , measure interstitial glucose levels every 5 to 15 minutes for 10 to 14 days.

These devices provide patterns of glucose excursions that can be the foundation for choosing or adjusting insulin doses in patients on multiple daily insulin regimens. These CGM devices are covered by Medicare in qualifying patients. See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'CGM systems'.

Retinopathy, nephropathy, and foot problems are all important complications of diabetes mellitus in older patients. Monitoring recommendations for older patients with diabetes are similar to those in younger patients table 3.

In particular, complications that impair functional capacity eg, retinopathy, foot problems should be identified and treated promptly [ 12 ]. Retinopathy — The prevalence of retinopathy increases progressively with increasing duration of diabetes figure 2.

See "Diabetic retinopathy: Classification and clinical features". Regular eye examinations are extremely important for older patients with diabetes because poor vision can lead to social isolation, an increased risk of accidents, and impaired ability to measure blood glucose and draw up insulin doses.

A complete ophthalmologic examination should be performed by a qualified ophthalmologist or optometrist at the time of diagnosis and at least yearly thereafter. The purpose is to screen not only for diabetic retinopathy, but also for cataracts and glaucoma, which are approximately twice as common in older individuals with diabetes compared with those without diabetes [ 55,56 ].

See "Diabetic retinopathy: Screening". Nephropathy — The availability of effective therapy for diabetic nephropathy with angiotensin-converting enzyme ACE inhibitors, angiotensin receptor blockade agents ARBs , mineralocorticoid receptor antagonists, and sodium-glucose co-transport 2 SGLT2 inhibitors has led to the recommendation that all patients with diabetes be screened for increased urinary albumin excretion annually.

See "Moderately increased albuminuria microalbuminuria in type 1 diabetes mellitus" and "Moderately increased albuminuria microalbuminuria in type 2 diabetes mellitus".

However, the prevalence of increased urinary albumin excretion increases in the older population for reasons unrelated to diabetic nephropathy.

For older patients who are already taking an ACE inhibitor or ARB and have progressive decline in glomerular filtration rate GFR or increase in albuminuria, referral to a nephrologist for further evaluation and treatment is warranted.

Foot problems — Foot problems are an important cause of morbidity in patients with diabetes, and risk is much higher in older patients. Both vascular and neurologic disease contribute to foot lesions.

See "Management of diabetic neuropathy". In addition to the increasing prevalence of neuropathy with age, more than 30 percent of older patients with diabetes cannot see or reach their feet, and they may therefore be unable to perform routine foot inspections.

We recommend that older patients with diabetes have their feet examined at every visit; this examination should include an assessment of the patient's ability to see and reach his or her feet and inquiry about other family members or friends who could be trained to do routine foot inspections.

Visits to a podiatrist on a regular basis should also be considered if feasible. A detailed neurologic examination and assessment for peripheral artery disease should be performed at least yearly. It is also important that prophylactic advice on foot care be given to any patient whose feet are at high risk.

See "Evaluation of the diabetic foot". In addition, they are at high risk for polypharmacy, functional disabilities, and other common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, mobility impairment, falls, and persistent pain [ 1 ].

See "Comprehensive geriatric assessment". All older adults should undergo screening for mild cognitive impairment or dementia at initial evaluation and, thereafter, annually or as appropriate for the individual patient [ 12 ].

Despite limited treatment options, identification of underlying cognitive impairment is critical for assessing a patient's capacity to self-manage diabetes treatment and care. In particular, cognitive function and the possibility of depression should be assessed in older patients with diabetes when any of the following are present see "Evaluation of cognitive impairment and dementia" and "Screening for depression in adults" :.

Nursing home patients — Few studies have focused on management of older adults with diabetes residing in nursing homes [ 4 ]. Life expectancy, quality of life, severe functional disabilities, and other coexisting conditions affect goal setting and management plans.

See 'Controlling hyperglycemia' above and 'Avoiding hypoglycemia' above. Treatment regimens should be chosen with a focus on avoidance of hypoglycemia and control of hyperglycemic symptoms [ 17 ].

For patients requiring insulin, metformin combined with once-daily basal insulin is an effective, relatively simple regimen. If prandial insulin is necessary, it can be administered immediately after a meal to better match the meal size and minimize hypoglycemia. Sliding scale insulin should not be used as a sole means of providing insulin.

If a patient is temporarily managed with sliding scale insulin to determine the requisite dose s of insulin therapy, a more physiologic glucose control strategy should be implemented within a few days table 4. End-of-life care — Management of patients with diabetes at the end of life must be tailored to individual needs and the severity of the illness.

In general, the risks and consequences of hypoglycemia are greater than those of hyperglycemia in patients at the end of life. The goal is to avoid extreme hyperglycemia and dehydration as well as excessive treatment burdens such as multiple insulin injections or intensive monitoring.

For patients with type 2 diabetes who are no longer taking anything by mouth, discontinuation of diabetes medications is reasonable [ 59 ]. This is in contrast to patients with type 1 diabetes, in whom continuing a small amount of basal insulin is required to prevent iatrogenic acute hyperglycemia and ketoacidosis.

See "Palliative care: The last hours and days of life", section on 'Eliminating non-essential medications' and "Deprescribing", section on 'Glucose-lowering medications'. SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately.

See "Society guideline links: Diabetes mellitus in adults". Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy, or frail with many comorbidities and functional disabilities.

Therefore, older adults in particular require individualized goals for diabetes management, keeping in mind their limited life expectancy and comorbidities.

See 'Goals' above. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in older adults.

See 'Avoiding hypoglycemia' above and "Hypoglycemia in adults with diabetes mellitus", section on 'Strategies to manage hypoglycemia'. See 'Cardiovascular risk reduction' above. The nutrition prescription is tailored for older people with diabetes based upon medical, lifestyle, and personal factors.

Exercise is beneficial to help maintain physical function, reduce cardiac risk, and improve body composition and insulin sensitivity in older patients with diabetes. See 'Lifestyle modification' above. Because of concern for hypoglycemia, some clinicians use insulin only for a short time to ameliorate glucose toxicity.

Once insulin secretion and sensitivity are improved, it may be possible to lower the dose or replace insulin with metformin or another oral hypoglycemic agent with lower risk of hypoglycemia.

See 'Choice of initial drug' above. Metformin will likely reduce glycemia safely at any level of hyperglycemia and further may reduce progression of hyperglycemia or the risk of developing diabetes-related complications.

See 'Metformin' above. An alternative option for patients who present with A1C near their medication-treated target and who prefer to avoid medication is a three- to six-month trial of lifestyle modification before initiating metformin.

The approach to choosing alternative therapy in metformin-intolerant patients is similar in older and younger adults. See 'Contraindications to metformin' above and "Initial management of hyperglycemia in adults with type 2 diabetes mellitus", section on 'Contraindications to or intolerance of metformin'.

The therapeutic options for patients who do not reach glycemic goals with lifestyle intervention and metformin are similar in older and younger patients. All of the medications have advantages and disadvantages table 2.

The choice of a second agent should be individualized based upon efficacy, risk of hypoglycemia, the patient's underlying comorbidities, the impact on weight, side effects, and cost figure 1. See 'Persistent hyperglycemia' above and "Management of persistent hyperglycemia in type 2 diabetes mellitus".

Another option is two oral agents and a glucagon-like peptide 1 GLP-1 receptor agonist. DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:.

DKA is dangerous and serious. You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. Ask your health care provider when and how you should test for ketones.

When you are ill when you have a cold or the flu, for example , check for ketones every four to six hours. If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test.

Often, your health care provider can tell you what to do over the phone. Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control.

Check with your health care provider about how to handle this situation. Diabetes Complications. Know the warning signs of DKA and check urine for ketones, especially when you're sick. What are the warning signs of DKA?

Copyright © Korean Geriatrics Society. View Full Site. Search Close. PDF Share Facebook Twitter Google LinkedIn Metrics Original Article J Korean Geriatr Soc. Published online June 30,

Objective: Diabetic ketoacidosis DKA is Reduce muscle pain life-threatening complication of both type 1 and DKA in elderly populations elerly diabetes. Eldelry aimed to assess population-based rates, trends populationns outcomes of DKA in elderly populations with DKA. Design and methods: This is a nationwide cohort study using hospital discharge claims data from to in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children yearsadolescents yearsand adults, and years. Analyses were stratified for type of diabetes mellitus and sex. Results: In total, 5, hospitalizations with DKA were identified, of whom 3, were seen in patients with type 1 diabetes and 1, in type 2 diabetes. Elevated ketones DKA in elderly populations a sign of DKA, which is a ederly emergency popullations needs to be ppulations right away. Diabetic popullations DKA is a serious complication Hydrating body washes diabetes DKA in elderly populations can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.