What it is
In type 2 diabetes, the body becomes resistant to insulin and the pancreas cannot produce enough to compensate, so glucose builds up in the blood. Over years, persistently high blood glucose damages small blood vessels and nerves, which is where most of the serious complications come from: eyes, kidneys, feet and heart.
It is extremely common in older Australians, and it is disproportionately common in some communities, including people of Middle Eastern, South Asian, Pacific Islander and Aboriginal and Torres Strait Islander background. If that describes your family, screening matters earlier and more often.
What changes with age
This is the part that is often missed. Diabetes management in an eighty-five-year-old is not the same as in a fifty-year-old, and tight blood glucose targets that made sense decades ago can become actively harmful.
The reason is hypoglycaemia - blood glucose dropping too low. In an older person it presents as confusion, unsteadiness, falls and, at worst, loss of consciousness, and it can look almost exactly like dementia or a stroke. The risk of a bad fall from a hypo often outweighs the benefit of a slightly lower HbA1c. Many geriatricians deliberately relax targets and de-prescribe in older patients.
Worth asking the GP directly: "Given their age and other conditions, are these blood glucose targets still right, and is any medication now doing more harm than good?" It is a reasonable question and a good GP will welcome it.
Feet
Diabetes damages nerves and reduces blood supply to the feet. The combination is dangerous: a person may not feel a blister, a stone in the shoe or a burn, and reduced circulation means what would have been a minor wound heals slowly, ulcerates, and in the worst cases leads to amputation.
Foot complications from diabetes are among the most preventable serious outcomes in older people, and prevention is unglamorous and effective: regular professional foot checks, appropriate footwear, skin and nail care, and looking at the feet every day.
Our co-founder Moustafa Raad is a practising podiatrist, and podiatry is a core part of what we deliver rather than something outsourced.
How it is usually managed
- Diet, activity and weight where appropriate and realistic
- Oral medication, and insulin for some people
- Blood glucose monitoring, at a frequency that suits the person rather than a protocol
- Annual eye checks, kidney function tests, and regular foot assessment
- Blood pressure and cholesterol management, which do as much for long-term outcomes as glucose control
Where aged care fits
- Podiatry - regular foot assessment, nail and skin care, footwear advice, and early identification of problems while they are still small.
- Registered nurse clinical care for wound care, insulin support and coordination with the GP.
- Help with self-administering medication, including prompting around meals where timing matters.
- Meal preparation and shopping assistance that work with the household's actual cuisine rather than against it. A diabetes plan that ignores what a family actually eats gets abandoned. We shop and cook to your household's food, including halal.
- Accompanied activities and transport to keep up regular walking and get to appointments.
Ramadan and fasting
Many older Muslims wish to fast, and diabetes complicates that significantly, particularly for anyone on insulin or sulfonylureas. This is a well-recognised clinical issue with established guidance, and the right approach is a conversation with the GP or endocrinologist before Ramadan about risk category, medication adjustment and monitoring - not a blanket instruction not to fast, and not fasting without adjusting anything. We will work around whatever plan is agreed.
General information only, not clinical advice. Diabetes management must be individualised by a GP or specialist. Diabetes Australia: 1800 177 055. My Aged Care: 1800 200 422.