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Mini P Thomas
Mini P Thomas

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Constant vigilance

26-Constant-vigilance

Elderly patients need to be counselled on diabetes care to avoid preventable complications

Diabetes strikes hard, making your body wither away like an old rotting tree trunk. Elderly patients can have multiple complications associated with diabetes. “They have a higher risk of heart diseases and stroke,” says Dr Amritava Ghosh, consultant diabetologist and endocrinologist, Narayana Multispecialty Hospital, Whitefield, Bengaluru. “Nerves to various organs in their body could get affected. Eye problems like diabetic retinopathy and kidney problems are common in such patients. They may be more prone to infections, too.”

About 15 per cent of patients with diabetes develop ulcers in their lifetime. “They have a high risk of amputation,” says Ghosh. In India, about 45,000 amputations occur every year. Experts say that diabetes is the leading cause of non-traumatic amputations, which constitute 50 per cent of all amputations.

Vegaraju Venkata Rajendra Prasad, 63, from Vijayawada, Andhra Pradesh has been suffering from type 2 diabetes mellitus for the past 12 years. Ulcers developed on his right foot and leg three months ago. “It started with a fungal infection between the toes. I rubbed the area with a towel, which made the skin peel off,” says Prasad, who is a retired employee of a private firm.

Prasad was immobilised for a long time because of the ulcers. He was not even able to attend to his business. On examining Prasad, Ghosh found that his limb was in danger, too. He had damaged nerves in the legs because of long-standing diabetes, which had affected the blood supply to his feet. “His sugar levels were also high,” recalls Ghosh.

Prasad was hospitalised and treated with antibiotics, insulin and surgical debridement, followed by wound care. He was screened for other complications associated with diabetes as well. “We treated the infection. Prasad had a significantly improved sense of well being as his sugar levels stabilised,” says Ghosh. However, his ulcers took longer to heal. “They healed two weeks after being discharged from the hospital,” adds Ghosh.

India presents a gloomy picture when it comes to care of the elderly diabetes patients. A significant portion of them live alone and they often miss insulin injections and follow-up visits. Elderly patients may fail to notice changes in skin colour or swellings in the feet. Lack of knowledge of how to take care of wounds makes matters worse and they end up having to undergo amputations that are preventable. “Those who develop diabetic foot have a mortality of up to 50 per cent in the next five years,” says Ghosh. “It is important that elderly patients are counselled on how to avoid injuries, wear proper footwear and monitor blood sugar levels on a regular basis.”

Diabetic retinopathy is on the rise even in well-controlled diabetes, says Dr Rohit Shetty, vice chairman, Narayana Nethralaya, Rajaji Nagar, Bengaluru. It is one of the most common causes of preventable blindness in the world. Elderly patients must consult an ophthalmologist if there is any significant change in their vision.

Diabetes can have a major psychological impact on older adults. The complications associated with the disease and the cost of health care contribute to higher incidence of depression in diabetics. Says Ghosh, “Elderly patients with diabetes are more likely to develop cognitive impairment as well.”

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Topics : #health

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