Diabetes mellitus

However, it is important to note that dietary and lifestyle changes in diabetes mellitus can :

• reduce the need for higher doses of diabetic drugs,
• possibly avoid the use of insulin in type 2 diabetes,
• improve the quality of life of the diabetic,
• delay the onset of complications of diabetes, and
• increase the lifespan of the diabetic

Another significant benefit in the very early stages known as pre-diabetes or impaired glucose tolerance (IGT) is that dietary and lifestyle changes can possibly prevent the onset of diabetes.

Diabetic Diet

Most of the glucose in the bloodstream at any time is sourced from the foods that are most recently eaten – mainly from carbohydrates but also from protein and fats to a lesser degree. A small amount of this glucose may also be from the glucose stores in the body. Understanding how foods impact on the blood glucose levels is therefore essential for making healthier choices to prevent glucose spikes and dips. Carbohydrates constitute the majority of the modern diet in the form of the different starches – bread and other wheat products, rice, potatoes and corn.

However, not all carbohydrates are made equal. Some breakdown rapidly causing a flood of glucose to enter the blood stream – these carbohydrates are known as high glycemic index (GI) or fast releasing carbohydrates. Other carbs breakdown gradually allowing for a constant glucose supply over a longer period of time without sharp spikes. These types of carbs are known as low glycemic index (GI) or slow releasing carbohydrates. Low GI carbs are the preferred option for diabetics.

Due to the impaired glucose control it is advisable that diabetics have 5 to 6 small meals in a day rather than 3 large to moderate sized meals. This allows the body to manage a sustained supply of glucose rather than contending with spikes and dips occurring throughout the day.

Diabetic Lifestyle

The diabetic lifestyle is not necessarily specific for people with diabetes mellitus – it is a generally healthy lifestyle which is advisable for most people whether diabetic or not. Exercise is the crucial factor in managing diabetes mellitus as physical activity improves the way the body handles glucose (tolerance). It does however require a commitment on the part of the diabetic as sporadic bouts of physical activity are not beneficial. Weight loss for the overweight or obese and maintaining a health body weight are also essential for the diabetic. As with exercise, it improves the body’s glucose tolerance.

There are several complications of diabetes meliltus which develop over time mainly affecting the eyes, circulation in the feet, heart and kidney function and nerve sensation particularly of the lower limbs. By being aware of these complications and carefully monitoring for any such changes, a diabetic can quickly seek treatment and minimize the effects of these conditions, some of which can be fatal. Even simple ailments like a open sore on the foot can have devastating consequences if it is not attended to speedily in the diabetic.

The Diabetic Senior

Seniors are at greater risk of developing diabetes mellitus. Should they be suffering with the condition from earlier in life, they are more likely to experience the more severe complications in the senior years. Although proper management with regards to diet, lifestyle changes and medication should be undertaken from the time of being diagnosed as a diabetic, extra care is needed for the elderly to avoid diabetes drastically impairing their lifestyle.

There are greater hurdles for the diabetic senior particularly with diet and lifestyle. Appetite changes with age, forgetfulness about medication and the right types of foods to eat coupled with impaired mobility making exercise a difficult task all contribute to problems with managing diabetes. However, this should not deter the senior diabetic from trying their utmost to incorporate dietary and lifestyle changes alongside their medication regimen in managing diabetes.

Reason why a heart attack occurs

The heart is a muscular pump that keeps blood circulating throughout the body. In this way blood laden with oxygen and nutrients can reach all the cells in the body. Similarly blood carrying waste and carbon dioxide can be routed to the different organs for disposal. In order to keep the heart muscle working throughout life it needs a very good supply of blood. The oxygen rich blood to heart is carried by the coronary arteries.

A heart attack occurs when one or more of these coronary arteries is blocked to an extent that the heart muscle gets very little or almost no oxygen-rich blood. Initially this causes injury to the heart muscle known as ischemia and eventually a portion of the heart muscle dies (infarct). This compromises the heart’s ability to pump blood. If a sufficient amount of heart muscle dies then the heart fails to perform it function to a sufficient degree to maintain life.

Causes of a Heart Attack

The most common cause of a heart attack is blockage of the coronary arteries by a build up of plaques in the artery walls. These plaques are a result of several factors including :

• high blood cholesterol
• high blood pressure
• diabetes mellitus (sugar diabetes)
• cigarette smoking
• obesity
• physical inactivity

These plaques develop over months and even years and this condition is known as atherosclerosis. A blood clot can suddenly block an already narrowed artery causing almost total occlusion of the artery within minutes or hours. Gradual narrowing of the artery that eventually compromises heart function is known as coronary artery disease (CAD).

Sometimes a heart attack can occur with the intake of certain substances, particularly narcotics like cocaine, where the coronary artery goes into spasm thereby cutting of the blood supply. Less commonly small tumors or blood clots from elsewhere in the body can block the coronary artery or the artery may even tear thereby leading to a heart attack. However, the most common cause of a heart attack is coronary artery disease as a result of atherosclerosis.

Heart Attack Age Risks

Not all heart attacks are fatal but even what is termed as minor heart attack can drastically compromise a person’s quality of life and reduce their lifespan in the long run. The elderly are at the greatest risk as heart attacks more commonly occurs in people over the age of 60 years. Even though a heart attack is more likely to occur in seniors, the processes like atherosclerosis that leads to a heart attack often starts earlier in life usually within the late 40s or early 50s onwards.

Death is more likely in heart attack patients over 75 years of age even if it is not immediately fatal. Men are at a greater risk of a heart attack but after 70 years of age, a heart attack is likely to affect both men and women equally. Despite the higher risk in the elderly, any man over 45 years of age and women over 55 years of age is still considered to be at risk.

Deep vein thrombosis (DVT) is one of the common leg vein problems in the elderly which has potentially serious complications if left untreated. It is simply the formation of a blood clot in the deep veins of the leg – mainly the lower leg but can occur in the thigh. On its own this clot can significantly impair the blood returning from the legs to the heart and cause a host of symptoms. However, the more serious and potentially fatal consequences can arise when the blood clot dislodges from the leg veins, travels through the bloodstream to reach the heart and lungs. The risk of this occurring is much higher in the elderly.

Causes of DVT

DVT is caused by a clot in the leg veins. A clot forms for one of three reasons :

1. Slow movement or stationary blood in the vein.
2. Damage to the wall of the vein.
3. Activation of clotting factors (chemicals) in the bloodstream to trigger clot formation.

Normally these three factors never come into play and blood flows constantly through a blood vessel or artery without an clotting. However, in some instances there may be certain causative conditions or risk factors that are more likely to activate one of these three mechanisms for clot formation. This is more likely with :

• Sitting or standing for long periods of time.
• Being restricted to bed rest.
• Obesity and being overweight.
• Cigarette smoking.
• Injury to the leg vein including surgery to the leg.
• Pregnancy or the use of oral contraceptives or hormone replacement therapy.
• Personal or family history of DVT.
• Heart failure.
• Cancer.
• Clotting disorders.

Age is another significant risk factor and DVT is more likely to occur after the age of 60. Seniors are therefore the highest risk group of not only developing DVT but suffering with the serious complications.

Signs and Symptoms

There may be no symptoms with DVT and it can remain unnoticed for long periods of time. When symptoms are present, DVT sufferers may notice :

• Swelling of the leg or sometimes even both legs.
• Cramping leg pain mainly in the lower leg, ankle and foot.
• Skin color changes such as paleness of the skin, or a red or blue discoloration.
• Warmth of the skin usually over where the clot is located in the leg.

When the clot dislodges in the leg vein, there is a major risk of it reaching the artery of the lung and obstructing it. This is known as a pulmonary embolism and is life threatening. It is therefore important that a person with DVT be aware of the symptoms of a pulmonary embolism and seek immediate medical attention should it arise. These symptoms include :

• Shortness of breath
• Chest pain
• Unexplained sweating
• Dizziness
• Fainting
• Anxiety

Many of these symptoms closely resemble a heart attack and irrespective of the cause, it signals the need for emergency medical attention. Pulmonary embolism may also present with coughing up of blood which is not seen with a heart attack.

Treatment of Deep Vein Thrombosis

DVT can be treated in several ways which are effective in preventing the clot from growing any further, reducing its size or obstructing it from reaching the vital organs in the trunk. One of the commonly prescribed options is a compression stocking. By placing more pressure on the leg, these stockings helps to ensure that blood does not flow backwards or become static which may increase the size of the clot. It also helps prevent swelling of the leg.

Regular use of a compression stocking along with exercises to improve leg circulation are very effective measures for managing DVT. Regular physical activity like walking also ensures that the blood in the legs are in constant flow. However, these conservative measures need to be adhered to and undertaken on a constant basis for it to be of maximum benefit. If it is insufficient then medication or a surgical procedure may be considered.

Medication used for DVT includes :

• Blood thinners to retard the growth of the clot.
• Clot busters to dissolve the clot.

If medication is not effective then a type of filter may be placed in the large vein to the heart (inferior vena cava). These filters, known as vena cava filters, prevents the clot from reaching the heart and lungs but can sometimes be the source of new clots.

Causes of Itchy Skin in the Elderly

There is no known cause for senile pruritus. In fact a diagnosis of senile pruritus should only be made once other possible causes of itchy skin without a rash has been excluded. Age-related changes in the skin especially drying of the skin is one of the leading causes but even with good skin care and the use of emollients (barrier creams), itching tends to persist in senile pruritus. The other factor is the general health status of a person and daily nutrition, both of which are affected to some degree with advancing age.

Skin Care

Skin health involves personal hygiene and good skin care. With regards to hygiene, it is sometimes a consequence of infrequent bathing but can equally be caused by overzealous washing. Bathing too frequently, scrubbing the skin with coarse bathing accessories and using strongly scented and antiseptic soaps all contributes to an itchy skin. Not using a sunscreen when outdoors and inadequate or infrequent moisturizing particularly in harsh environmental conditions – hot and strong sunlight, cold and dry climates.

Drugs

Another significant cause of skin itching without a rash is as a side effect of using certain medication. This is known as an iatrogenic cause. The elderly are more likely to have certain chronic diseases and are therefore more likely to be using chronic medication and combinations of drugs simultaneously. Itchy skin is one of the more common side effects of most drugs.

Sometimes the drug interaction of two or more drugs causes symptoms such as itchy skin which are not well documented for each drug on its own. It is difficult to isolate specific drugs that may cause itchy skin due to the prevalence of this side effect or possibility of drug interaction. It is known that pain relievers, aspirin, antibiotics and antifungal drugs are more likely to cause itchy skin. There is some evidence that even certain nutritional supplements are likely causes.

Diseases

Various skin diseases can affect the elderly or may be chronic and have started earlier in life. These skin diseases may go through phases where there is no skin rash present. However, itching of the skin can be continuous and even severe. Eventually a skin rash erupts and may then resolve again with or without treatment. It is therefore important for the elderly to inform their doctor of their previous history of skin diseases especially conditions such as atopic dermatitis, psoriasis, and known drug allergies that caused skin symptoms on previous occasions.

Systemic causes refers to diseases that affect one or more organs in the body or even the entire body and is not specific to the skin. Some systemic causes that can cause intense itching of the skin even without a skin rash includes :

• Kidney failure
• Liver disease
• Iron deficiency anemia
• Certain types of cancer, although it is not skin cancer
• HIV/AIDS
• Stroke

Psychological and Social

Psychogenic itching is the term for psychological causes of an itchy skin. Sometimes it is just imagined while at other times it is linked to mental health disorders such as depression and dementia. The elderly especially those who tend to live alone or have disabilities are also less likely to be able to bathe themselves, clean bed linen or clothing frequently or may have very close contact with pets all of which can contribute to skin itching.

Peptic ulcer disease (PUD) is a condition where open sores form in the wall of the upper gut, namely the esophagus, stomach or duodenum (first part of the small intestine). It is a common condition that develops for many of the same reasons as gastritis. Peptic ulcers may follow a long or severe bout of gastritis that is not quickly treated and effectively managed. It is one of the common gut problems that affect the elderly especially those using certain chronic medication like NSAIDs (non-steroidal anti-inflammatory drugs). Apart from causing severe discomfort, peptic ulcers can lead to very serious complications when left untreated.

Causes of Peptic Ulcer Disease

The lower end of the esophagus (food pipe), stomach and first part of the small intestine known as the duodenum have to at times contend with the too much stomach acid. While the stomach has a mucus barrier to prevent the acid from damaging its wall and the duodenum has several mechanisms to neutralize any incoming acid, certain causes can compromise its protective mechanism. Even in the normal state, this protection is sometimes insufficient when there is excessive acid.

The esophagus had neither a significant barrier nor very effective mechanisms to withstand acidic contents. In the ideal situation the acidic stomach content should never enter the esophagus. It does occur at times especially when there is too much acid in the stomach or the sphincter between the stomach and esophagus does not prevent acid back flow.

Ulcers develop when there is too much acid or too little protection to acid in the esophagus, stomach or duodenum.This is caused by two factors in particular – H.pylori bacteria and frequent use of certain medication.

• H.pylori (Helicobacter pylori) is a bacteria that can withstand the stomach acid and burrow into the stomach wall and lead to an ulcer.
• Excessive use of medication like NSAIDs and osteoporosis drugs can also cause ulcers.

The latter cause is more likely in the elderly, many of whom use NSAIDs on an ongoing basis to reduce pain and inflammation in certain chronic disease like arthritis. It is also more likely since bone diseases such as osteoporosis mainly affects the elderly and medication is therefore necessary to manage this condition. Peptic ulcers may be more likely to occur and worsen in a person who drinks alcohol and in smokers.

Signs and Symptoms

Peptic ulcers generally presents with pain. The location of this pain can vary within the upper middle region of the abdomen. Other characteristics of peptic ulcer pain includes :

• Pain that worsens at night.
• Pain is intense for a few days, resolves for days or weeks thereafter, only to return again.
• Pain that is worse when hungry and eases for a short period after eating.
• Pain that eases with antacids or other acid-suppressing drugs.

Sometimes pain is the only symptom that is present. In more severe cases a person may experience other symptoms such as :

• Nausea and sometimes vomiting.
• Blood in the vomit which can vary from bright red to dark ‘coffee ground’ appearance.
• Dark blood in the stools known as melena that makes the stool appear black and tarry.
• Changes in appetite.

Blood in the vomit or stool is a sign of a bleeding ulcer and needs to be attended to immediately. Less commonly, an ulcer can penetrate the entire wall of the gut and leak contents into the abdominal cavity causing a serious condition known as peritonitis.

Treatment of Peptic Ulcers

Peptic ulcers can be very effectively treated and managed over the long term. It involves the use of medication such as :

• Antacids to neutralize stomach acid.
• Acid suppressing drugs to reduce acid production.
• Medication to line the ulcers thereby protecting it from the acid and allowing it to heal.
• Antibiotics to eradicate the H.pylori bacteria.

For the elderly there is the additional factor of whether to change or stop certain chronic medication that may be causing ulcers. These drugs should not be discontinued without medical supervision. Instead a doctor will prescribe alternative drugs where possible that are less likely to lead to ulcers.

Leg Blood Circulation Problems

Arteries carry blood that is rich in oxygen and nutrients to the legs. Veins on the other hand carry oxygen deficient blood that has wastes back up to the trunk to be processed by the liver and funneled by the heart to the lungs.Three different common conditions can arise in the arteries and veins of the legs.

• Peripheral arterial disease (PAD) is where the arteries of the leg is narrowed and gradually hardens due to the formation of plaques within the arterial wall. It is linked to high blood pressure, high blood cholesterol, diabetes mellitus, cigarette smoking and other factors.
• Varicose veins is where the superficial veins of the legs becomes enlarged. Blood tends to pool within these veins causing it to become dilated and twisted. It is associated with obesity, a sedentary lifestyle, standing and sitting for long periods and hormonal changes.
• Deep vein thrombosis (DVT) is where a blood clot forms in the deeper veins of the legs thereby obstructing blood flow, either partially or completely. It tend to arise for many of the same reasons as varicose veins and can arise as a complication of varicose veins.

The treatment for both artery and leg vein problems may differ but it is largely improved and prevented by certain measures that may be common to both types of circulatory disorders. The medical and surgical treatment of these conditions should be discussed with a doctor and vascular surgeon.

Ways to Increase Blood Circulation

Exercise and even moderate physical activity can be helpful in preventing artery and vein problems in the leg. Once these problems do set in however, physical activity can often worsen the symptoms such as leg pain or swelling. Nevertheless the worsening of symptoms with activity does not mean that the condition is getting worse. The different ways to aid circulation in the legs should be discussed separately under artery and vein problems.

Artery Circulation

When the artery is narrowed or becomes hard, the blood flow to the lower leg and feet is impeded. In many cases this does not cause a major problem. When it is severe, walking can lead to pain as the tissue of the feet and leg do not receive adequate oxygen and nutrients. This should not discourage a person from walking and undertaking related physical activity. There is a risk of clots developing on and around the plagues in the artery and activity reduces the chances of clot formation.

Elevating the legs like when lying down only slows down blood flow further. Instead the legs should be slightly lower than the trunk so that the action of gravity can help blood push passed the narrowing to reach the feet. This is the reason that many people with peripheral arterial disease find that hanging their leg over the bed helps ease pain in the lower leg and feet during sleep. Compression stockings should not be used as this can further impede blood flow to the lower parts of the leg.

Vein Circulation

Exercise and moderate physical activity also assists in circulatory problems involving the leg veins but for slightly different reasons than is the case for the arteries. When the leg and feet muscles contract, it helps to push the blood in the veins slight higher up the leg. These muscles essentially act as a pump to return blood to the trunk. Both varicose veins and deep vein thrombosis are worsened by blood that is stagnant. Therefore movement of blood is best aided with exercise.

Elevating the legs is also helpful in circulatory problems in the legs veins. By raising the legs above the level of the heart, the blood can drain back up the leg to the trunk. This prevents the blood from congesting the legs, stretching the veins further, slowing the flow of oxygen rich blood to the legs or encouraging the formation of clots in the veins. Compression stockings are also helpful in conditions like varicose veins as it prevents the vein from enlarging and leading to incompetent valves. Even if walking around is not always possible, like when sitting for long periods during road or air travel, simple exercises of the calf and feet while sitting may assist with blood flow.

Although these measures are helpful, it should not detract from the need for medication and surgery in some cases. Proper medical management is essential to prevent complications like leg ulcers or more serious and life threatening conditions like pulmonary embolism in patients with DVT. Lifestyle changes like losing weight, opting for a low fat diet and stopping cigarette smoking are also essential.

Why are seniors at greater risk?

Most seniors may not be as sexually active as their younger counterparts but are nevertheless having sexual contact if not regularly then at least on an infrequent basis. Despite less sexual contact, seniors may often be at greater risk of contacting STDs for one or more of the following reasons :

• Seniors may be less likely to use contraceptives like condoms since they are not concerned about unwanted pregnancies.
• Seniors are more likely to be having sexual contact with other seniors. The belief that other elderly people are less likely to be a risk may not compel them to use condoms.
• Older women are more likely to experience tiny tears in the vaginal wall during intercourse due to thinning of the tissue after menopause and vaginal dryness. This increases the chances of transmission of microbes responsible for these infections
• Age related changes in the immune system means that it is not as capable of fighting off infections as is the case in earlier life. It may also means that some of the very early symptoms which is due to the immune response to the presence of the microbes may not be as evident.
• Seniors rarely consider regular screening for STDs due to ignorance about the risk of contracting these infections later in life. They are therefore unaware that they have an infection and may pass it on unknowingly.
• Ignorance and embarrassment about sexually transmitted diseases may mean that seniors do not receive treatment and continue to have sexual contact thereby spreading the disease.

Dangers of STDs in the Elderly

While prevention is better than cure, most STDs can be effectively treated. However, with the risk in diseases like HIV/AIDS, seniors should rather be cautious, practice safe sex and avoid risky behavior so as not to contract any infection in the first place. All of these diseases when left untreated will run through a clinical course and eventually lead to complications some of which are potentially fatal. This will occur irrespective of the age of a person. In the elderly however, there is a greater danger with STDs for one or more of the following reasons :

• STDs may lead to complications faster due to a weaker immune system.
• STDs may affect the management of existing chronic conditions. Conversely the presence of pre-existing conditions may compromise the treatment of an STD.
• STDs or the treatment for it may increase the chances of developing certain diseases which may also be more likely to be seen in the elderly.
• STDs can significantly hamper the quality of life of any person but in the elderly this may be further exacerbated with the impact of pre-existing diseases and the effects of aging.

Sometimes the stomach wall becomes injured or irritated and this condition is known as gastritis. It is more likely to happen in certain people particularly the elderly who use excessive amounts of chronic medication. Gastritis can be a painful stomach condition and affect a person’s lifestyle and eating habits to a significant degree. Without treatment and in severe cases, gastritis can quickly progress to stomach ulcers and even bleeding in the upper gut.

Causes of Gastritis

Every person experiences the odd case of gastritis but in most individuals it quickly heals and the symptoms resolve. Ongoing gastritis is more likely to happen when some factor disturbs the mucus barrier in the stomach. This protective layer of mucus ensures that stomach acid within the stomach never touches the walls of the stomach directly. It is maintained by tiny mucus-producing cells throughout the stomach lining. Various factors can irritate the stomach lining in the short term but should it also affect the mucus barrier, then the irritation can then go on as the acid damages the stomach wall.

The two most common causes of gastritis is H.pylori (Helicobacter pylori) bacteria and the use of non-steroidal anti-inflammatory drugs (NSAIDs). H.pylori bacteria causes an ongoing infection over months and years. It is passed on from person to person through direct contact and often affects several members in a family at the same time. NSAIDs can cause acute stomach irritation in the short term but when it is used on an ongoing basis it leads to chronic gastritis. This is especially significant for the elderly who may be using these drugs to treat and manage certain chronic diseases.

Gastritis can also arise after a period of debility or severe illness, with exposure to radiation, alcohol abuse, and sometimes with certain autoimmune diseases. Any of these causes can lead to erosive or non-erosive gastritis – erosive referring to the formation of open sores in the stomach (ulcers) and non-erosive meaning stomach inflammation without open sores. Other factors like spicy foods, cigarette smoking and psychological stress can worsen gastritis but do not cause the condition.

Signs and Symptoms

Chronic gastritis can exist for long periods of time with little or no symptoms. It is only during the acute phase that symptoms become prominent. This includes :

• Burning or dull gnawing stomach pain – in the upper left portion of the abdomen.
• Nausea and indigestion
• Bloating – a sensation of feeling full sometimes after eating just a few bits
• Vomiting occurs in more severe cases with signs of blood in the vomit if there is a bleeding ulcer.
• Changes in appetite

Treatment of Gastritis

The way gastritis is treated depends on the underlying cause. This can sometimes be complicated in the elderly who are on chronic anti-inflammatory drugs which may be causing the gastritis. The medication may first be changed to other drugs that are milder on the stomach and less likely to cause gastritis before the gastritis treatment itself is commenced. The various medication for treating gastritis includes :

• Antacids which offer symptomatic relief but will not treat gastritis on its own.
• Acid suppressing medication like proton pump inhibitors (PPIs) which reduces stomach acid production and allows the stomach lining to heal.
• Antibiotics to treat H.pylori infection and is known as eradication treatment.

The stomach lining regenerates very rapidly and in acute case of gastritis and healing may occur without any medication in some instances. However, it is important to seek professional medical advice and commence treatment where necessary to prevent complications like stomach ulcers.

Types of Diabetes Mellitus

There is broadly three types of diabetes mellitus :

• Type 1 diabetes mellitus which tends to start in early life, hence the outdated term juvenile diabetes, although it may start within the 30s and 40s.
• Type 2 diabetes mellitus which is more common and can start from the 20s onwards. It may be termed early onset if it begins before 60 years of age or late onset if its starts after the age of 60.
• Gestational diabetes also commonly referred to as pregnancy diabetes which starts when a woman is pregnant and often resolves shortly after childbirth although it can continue for life thereafter.

Causes of Diabetes Mellitus

Diabetes mellitus is simply a problem with controlling the blood glucose levels thereby leading to high glucose levels (hyperglycemia). Normally the pancreas secretes a hormone known as insulin to lower blood glucose levels should it rise. Another hormone known as glucagon can raise blood glucose levels when it falls too low. In this way the body can maintain the blood glucose levels within a normal range at any time of the day or night. Glucose is essential for the cells to produce energy and is needed for every process in the body to run efficiently. Most glucose is sourced by breaking down carbohydrates that are eaten but even protein and fat can be converted into glucose. High levels of glucose however can damage cells and lead to a host of complications.

The hormone insulin forces cells to take in more glucose and for excess glucose to be stored away in the liver as glycogen or throughout the body as fat. In this way insulin removes glucose from the bloodstream when the glucose levels are too high. It also signals the liver to not produce any additional glucose either from the food it is processing or its glucose stores. In diabetes mellitus this control of blood glucose levels by insulin is impaired. In type 1 diabetes mellitus the pancreas cells that produce glucose is damaged leading to a lack of insulin (insulin deficiency). With type 2 diabetes mellitus the cells of the body stop responding to the insulin and this is known as insulin resistance. A similar process to type 2 diabetes mellitus occurs in gestational diabetes possibly as a result of the high levels of female hormones in circulation during pregnancy.

Although genetic factors play a significant role in diabetes mellitus, the influence of other lifestyle factors particularly with type 2 diabetes mellitus are important considerations. This includes :

• Obesity or being overweight
• Age as the chances of developing diabetes increases as a person gets older
• Sedentary lifestyle
• Family history of diabetes
• High blood cholesterol or triglyceride levels

Apart from age and family history, most of the other factors are modifiable meaning that it can be changed or avoided.

Signs and Symptoms

Diabetes mellitus is initially asymptomatic meaning that there may be no signs and symptoms especially in the stage just before diabetes fully develops known as pre-diabetes. In the elderly, the signs and symptoms can often be mistaken for side effects of chronic medication or other diseases. Therefore it is important to undergo regular testing to monitor the blood glucose levels rather than depending on the onset of the various symptoms.

• Increased thirst – feeling thirsty often despite not being more active or not perspiring excessively in hot weather.
• Frequent urination – urinating many more times in a day that is your normal pattern and especially awaking at night to urinate.
• Fatigue – feeling uncharacteristically tired even without extra physical activity which is sometimes just passed off as low energy levels.
• Increased hunger – eating more frequently, feeling hungry shortly after eating and sometimes ravenous hunger.
• Unexplained weight loss – losing weight for no known reason despite eating more food and being as active as is normally the case.

Over time and as the diabetes worsens, a person may start noticing additional symptoms such a repeated infections, wounds that do not heal properly or as quickly, blurred vision, unexplained headaches and fruity odor to the breath. Once the complications of diabetes mellitus sets in, more severe symptoms will become apparent.

Eye strain

Causes of Eye Strain

The main cause of eye strain is fatigue of the eye muscles. These intrinsic muscles are very tiny and are accustomed to constantly relaxing and contracting to alter the incoming light at the pupil and bending of light through the lens. This allows for visual acuity. The extrinsic muscles of the eye control movement of the eyeball which allows for vision in several directions without having to move the head. With certain activities these muscles may have to maintain its position or be overexerted for long periods of time thereby leading to eye strain. Apart from the muscle strain, blinking less frequently or reduced tear production and secretion can further contribute to eyestrain.

A person is more likely to experience eyestrain if they are :

• Staring at a computer screen or television for long hours.
• Reading for long periods of time in a single sitting.
• Driving for long distances.
• Not using corrective lenses when they have refractive errors of the eye like myopia (short sight) or hyperopia (far sight).
• Conducting the activities mentioned above in very bright or dim light.

The elderly are more prone to eye strain as the changes that occur in the eyeball to accommodate for sharp vision is impeded to some extent with age. The pupillary reaction to light may be slow or not as effective as in the younger years, the lens loses its elasticity and tear production may be lesser than normal in the senior years. This can be further complicated by age-related eyesight problems like presbyopia, cataracts and glaucoma which are more common in seniors.

Signs and Symptoms

The typical symptoms of eye strain includes :

• Burning and itching eyes
• Redness of the eye / eyes
• Watery eyes
• Soreness or eye pain

Some people may also experience dry eyes, light sensitivity and blurred or even double vision in severe cases of eye strain. Although uncommon, sometimes eye strain does not present with any prominent eye symptoms. Instead a person may experience vague and non-specific symptoms that can be misleading as to the diagnosis. These symptoms may include :

• Headaches
• Neck and shoulder pain
• Back ache
• Fatigue

Treatment of Eye Strain

There is no specific medical treatment that is necessary for eye strain. In most cases the symptoms will resolve within minutes or hours. However, repeated eye strain can lead to various vision problems that may become permanent. The focus should be on preventing eye strain with the following measures :

• Always use corrective eye glasses as prescribed.
• Artificial tear drops are available over-the-counter and can help relieve dry eyes.
• Give the eyes a break during long periods that may cause eyestrain.
• Use sunglasses or photosensitive lenses of spectacles that can reduce harsh sunlight when outdoors.
• Blink frequently during long term eye use.
• Reading in the proper lighting is also important – dim light is usually insufficient for the elderly in particular while excessively bright light can be harsh on the eyes.