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What complications does high blood sugar cause in the elederly?

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Posted on Mon, 28 Jul 2014
Question: My father, now 76 years old, had diabetes diagnosed at age 37. He developed cardiac problems, underwent angioplasty in 2001 and bypass surgery in 2009. Now his fasting blood sugar is around 200 consistently and his blood pressure has been high atleast since last December. He refuses to take any insulin injections and lives with my aged mother. What is the likely health situation that he can be in within the next 6 months if the fasting BS levels do not drop to 90, as recommended by his cardiac surgeons?
doctor
Answered by Dr. M. Vamsi Krishna (21 minutes later)
Brief Answer:
Diabetes control in ealderly should be relaxed

Detailed Answer:
Dear sir,

I am very sorry for the diabetes control of your father.

In elderly individuals the diabetes control should be relaxed. very tight control of diabetes control like 90 fasting might be dangerous with risk of hypoglycemia.
As you rightly said insulin is the best option for your father.
There are many new types of basal insulins.
Available like traceba, Lantus which can be taken once daily
The new insulins are coming with pen device which are having 31 gauge needle.this needle will never give pain when injected.
Much deterioration of health is not expected from this level as insulin requirements will decrease in elderly,
The risk of cardiac events will be there irrespective of present glycemic control mostly due to age as a factor.

Relax he will do better with grace of almighty.
I am ready for further discussion.
Dr Vamsi
Diabetologist
Apollo hospitals
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. M. Vamsi Krishna (1 hour later)
Thank you, Dr XXXXXXX for your prompt reply.
What is the fasting BS level he should aim for?
My mother is scared stiff about the possibility of stroke and kidney dysfunction.
The diabetologist my father visits as not mentioned stroke but said that high blood sugar can gradually affect the kidney. He did not define gradual.
I am more concerned about the cardiac system, as already in 2009 he had too many blocks to be operated on, therefore requiring bypass.
On the other hand, my father now brings carbohydrate-rich food home and expects my mother to prepare them and serve him as food, even though they both know it is poison for him.
We worry. Do we have cause for it? Should we tone down, as my father insists we do? he wishes to be left alone for the next 6 months with no one mentioning medical status or complications to him.
confused and worried daughter.
doctor
Answered by Dr. M. Vamsi Krishna (13 minutes later)
Brief Answer:
Diet control is must

Detailed Answer:
Dear madam

Thanx for providing the best history.
Kidney damage can be monitored by doing test like micro albumin and serum creatinine
Elderly individuals with the growing age will behave more childish in nature. They should be dealt in the same way as small children. We should spend some time in giving counseling to them and we should never shout at them.

They should be kept happy so that their acceptance for treatment will increase.
In my opinion, rather than insulin it's first better to convince him for a better diet.

In case of depression also they tend to eat more so by making him happy we can keep away depression and sugars can also be improved.
The word gradual means in a span of 4 to 5 yrs but it's highly variable and needs regular monitoring once in 6 months at least
The logical fasting BS for patients at your dad age is around 150

Kindly write back to me for any further clarification
Regards
Dr Vamsi
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. M. Vamsi Krishna (1 hour later)
Thank you for your prompt reply.
His prescription at present is as follows:
Diamicron 80 mg, 1-1
Metolar 25 mg, 1/2-1/2
Avas 20 mg, 0-1
ASA50, 0-2-0
Citaper 500 mg, 0-1 (not yet begun taking)
RenervePlus, 0-1 (not yet begun taking)
Insulin inj, 12-0-8 (not yet begun taking)
My father wishes to know your opinion on this prescription.

doctor
Answered by Dr. M. Vamsi Krishna (28 minutes later)
Brief Answer:
Excellent prescription

Detailed Answer:
Dear madam

It's a great prescription
In my opinion insulin can be replaced by single shot of inj Lantus which is very safe in ealderly individulals
Lantus will not have hypoglycemia when compare to premix insulin
By controlling his diet, I guess we can solve 80% if problem
Kindly let me know about his lab reports and hba1c is very important test which need to be done every 3 months
I am at your service any time

regards
Dr Vamsi Krishna
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. M. Vamsi Krishna (12 minutes later)
Dear Dr XXXXXXX XXXXXXX
Thank you for your prompt answer, which I have conveyed to my parents.
They will get the test results out and I will convey them to you as soon as I have them.
with many thanks,
relieved daughter
doctor
Answered by Dr. M. Vamsi Krishna (9 minutes later)
Brief Answer:
I will be looking for your fathers reports

Detailed Answer:
relax madam
if you know about diabetes it's very easy to Control
pls never panic in life regarding diabetes
as you are having family history of diabetes I suggest you to go for exersise for 45 mins and keep your self fit
this is enough to keep diabetes away from you
regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. M. Vamsi Krishna (49 minutes later)
will do, many thanks.
doctor
Answered by Dr. M. Vamsi Krishna (1 hour later)
Brief Answer:
You welcome

Detailed Answer:
most welcome
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. M. Vamsi Krishna

Diabetologist

Practicing since :2007

Answered : 988 Questions

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What complications does high blood sugar cause in the elederly?

Brief Answer: Diabetes control in ealderly should be relaxed Detailed Answer: Dear sir, I am very sorry for the diabetes control of your father. In elderly individuals the diabetes control should be relaxed. very tight control of diabetes control like 90 fasting might be dangerous with risk of hypoglycemia. As you rightly said insulin is the best option for your father. There are many new types of basal insulins. Available like traceba, Lantus which can be taken once daily The new insulins are coming with pen device which are having 31 gauge needle.this needle will never give pain when injected. Much deterioration of health is not expected from this level as insulin requirements will decrease in elderly, The risk of cardiac events will be there irrespective of present glycemic control mostly due to age as a factor. Relax he will do better with grace of almighty. I am ready for further discussion. Dr Vamsi Diabetologist Apollo hospitals