DIABETES MANAGEMENT IN OLDER PEOPLE

Diabetes Management in Older People

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Diabetes Management in Older People

One of the pancreases functions is to monitor the level of blood glucose. If blood glucose levels become too high ß cells in the islets of langerhans discharge insulin. Insulin then travels around the body in the blood, but exerts an effect mainly on cells in muscles, liver and adipose tissue. This hormone acts in the body by lowering blood glucose and making the cell surface membranes more permeable to glucose. It activates transport proteins in the membranes, allowing glucose to pass into cells, as well as this insulin also activates enzymes in the cells. A proportion of these enzymes convert glucose into glycogen whilst other enzymes increase protein and fat synthesis. If the levels of blood glucose get to low ? cells in the islets of langerhans secrete glucagon. This hormone fits into the receptor sites on cell surface membranes and activates the enzymes inside the cells that convert glucogen into glucose. The glucose then passes out of the cells and into the blood, raising blood glucose levels.

Blood clotting involves three simultaneous and overlapping processes: the formation of a plug from platelets in the blood; binding the platelet plug to the site of injury to form a clot; and confining the clot to the area of injury. Normal platelets and normal clotting factors are needed for effective clotting. The older person is more prone to bleeding disorders than the younger person, and the causes for the disorders are different and more complex. A simple classification are conditions that reduce the number of platelets in the blood, platelets that do not function properly, and abnormalities in the clotting factors.

Liver disease is also an illness that has a major impact on blood clotting and coagulation as the liver has an important role in the coagulation process and thus clotting abnormalities are a prominent feature of acute and chronic liver disease.  Liver disease, in particular chronic liver disease is seen more in older patients, in particular the elderly.  This can be due to many reason such as long term alcohol abuse, cardiac dysfunction, diabetes and hepatitis.  The key point to note here is that even though younger individuals may suffer from these illnesses, it is the long-term effects of them that tend to cause major complication and they only normally tend to manifest after many years or in later life.  In patients with chronic liver disease, particularly the elderly, bleeding can reflect primarily anatomic or specific abnormalities of the coagulation system (Mancuso et al 2003).  The outcome is often portal hypertension eventually leading to esophageal and gastric varices, hemorrhagic gastritis and volume overload in the portal system.  These conditions may lead to severe gastrointestinal hemorrhage and bleeding due to quantitative and qualitative platelet and coagulation factor abnormalities, for example, normally 30% of the platelet pool is sequestered in the spleen, however, in the presence of portal hypertension this figure can rise to as much as 90% leading to a large reduction in the circulating ...