SLUCare Physician Group

Hazel Nicholson, 71, discovered she had diabetes more than 25 years ago, when she had her blood sugar level checked at a health fair. She hadn’t experienced any symptoms, but the disease ran in her family. In the years since, Nicholson has tried many doctors and medications, but after more recent, specialized care by SLUCare physicians, her condition finally is under control. “I used to have a single doctor for all my ailments, but having a diabetes specialist who can focus on the specifics of my disease has made me feel much safer,” she says.

“For seniors, diabetes is a double-edged sword and we have to be careful,” says SLUCare endocrinologist Dr. Deepashree Gupta, Nicholson’s doctor. “Too little medication and the condition can worsen; too much and there’s a risk of serious side-effects.” SLUCare physicians are paying close attention to the delicate balance required in the management of the Type 2 diabetes, which reportedly affects about one in four people over age 60.

Whereas Type 1 diabetes (usually diagnosed in childhood) is caused by the body’s inability to produce the hormone insulin, Type 2 diabetes can occur because of risk factors like obesity, inactivity and family history, and often is accompanied by high blood pressure, high cholesterol and increased risk of heart attack and stroke. In worst case scenarios, diabetes can cause blindness and affect nerve and kidney function.

Dr. Alan Silverberg, SLUCare endocrinologist, says the disease can be complicated significantly by advanced years, when so many other conditions might be present. Treatment must be considered carefully, he says, and not only take into account other medical problems, but factors like drug cost for patients on Medicare/Medicaid, memory issues, problems with eyesight and even injection skills. “If you can’t remember to take your pills, or the pharmacist hasn’t taught you properly how to give yourself a shot, then your medication regimen will be affected.” he says.

“Another issue,” adds Gupta, “is that while we have to control sugar levels, we also have to manage the possible side effects that drugs like insulin can cause. These medicines are dangerous for elderly people if they are over-used.” For example, the medicines prescribed to lower blood sugar can bring on hypoglycemia, which can cause fainting, cognitive dysfunction and even stroke. “Older people aren’t as strong and are more susceptible to side effects that are unacceptable,” Gupta says, adding that medications like metformin and DPP-4 inhibitors can be safer than insulin. But while metformin comes in generic form and consequently is less expensive, DPP-4 inhibitors don’t and are much pricier.

Meanwhile, SLUCare geriatrician and director of endocrinology Dr. John Morley emphasizes the vital role of exercise in diabetes management, explaining that diabetics experience an accelerated loss of muscle mass as they age. Consequently, they have fewer insulin receptors, are weaker and have an increased risk of falling. The solution, he says, is to rebuild muscle with vigorous resistance exercise, which will boost receptors and make insulin shots more effective. “I keep telling everyone that it comes down to exercise,” Morley says.

Nicholson has listened carefully to her doctor’s advice. “I do what Dr. Gupta tells me,” she says. “I eat right, I exercise, and I know how to take my medications. I’m on a good path.”

SLUCare physicians are leading the way in geriatric diabetes care. Pictured on the cover: Dr. Deepashree Gupta and Dr. Alan Silverberg. For additional information, visit slucare.edu/diabetes. 

Pictured: SLUCare endocrinologist Dr. Gupta talks to a patient.
Photo courtesy of SLUCare Physician Group
Cover design by Julie Streiler | Cover photo courtesy of SLUCare Physician Group