Managing Type 2 diabetes: A lifestyle guide for older adults

Did you know that type 2 diabetes is the most common form of disease to develop in older adults? In fact, more than 38 million Americans have diabetes (about 1 in 10) and about 90-to-95 percent of them have type 2 diabetes, according to the Centers for Disease Control and Prevention.

I’ve been a nurse practitioner caring for older adults for more than 25 years, and much of this time has been spent working with patients who have diabetes. While diabetes can present a challenge to all patients, there are issues that are specific to older adults. I often see that adults who struggle with physical activity, finances, and getting to the grocery store also have difficulty managing their diabetes. Some patients express that they just want to enjoy their food and relax without having to constantly worry about their diabetes.

The good news is that small lifestyle changes can make a difference in helping to effectively manage your diabetes and help you continue enjoying a fulfilling, active life.

Understanding Type 2 diabetes

It’s important to start at the beginning when talking about diabetes in order to give people the information they need to take control of their diagnosis. Since Type 2 diabetes is a chronic condition of not enough insulin, it helps to understand what insulin does. After eating, the body breaks down the food, specifically carbs into sugar. The sugar goes into the blood for delivery to cells, including muscles, to use for energy. Insulin “opens the door” to let the sugar in to provide energy. Without insulin, the sugar stays in your blood (“blood sugar”) and winds up in places where it can do harm.

When your body has trouble with insulin, you can end up with too much sugar in your bloodstream (aka your “blood sugar”), which can wreak havoc on your health if left untreated. However, with the right treatment plan, you can keep your blood sugar levels in check and reduce the risk of complications. While some people may need medications to help control their diabetes, all people will benefit from a healthy lifestyle.

If left untreated or uncontrolled, older adults with diabetes are at greater risk for developing complications related to their condition, including hypoglycemia, heart disease, and kidney failure.

Above all, taking care of your diabetes means having a routine for things like meals, exercise and medicine. Let's explore some key strategies I use to help patients set up simple routines and take charge of their health while living with type 2 diabetes.

Healthy eating habits

Adopting a balanced diet is one of the most important steps in managing diabetes. My favorite tips are straightforward and apply to healthy aging in general:

Focus on whole foods: Incorporate plenty of vegetables, whole grains, lean proteins, and healthy fats (such as those found in nuts, seeds, and fish) into your diet. Fresh or frozen fruit can be a healthy dessert option. These foods provide essential nutrients and help stabilize blood sugar levels. If shopping is challenging, frozen foods have almost exactly the same nutrient content.
Watch your portions: Eating smaller meals can prevent spikes in blood sugar. Be mindful of portion sizes, especially when it comes to carbohydrates. A good rule of thumb is to make half your plate greens, one-quarter of the plate carbohydrates and on-quarter a lean protein.
Limit sugary foods: Cut down on sugary snacks and beverages. Opt for healthier alternatives like fresh fruit, nuts, or yogurt when you crave something sweet.
Stay hydrated: Drink plenty of water throughout the day. Avoid sugary drinks and opt for water, herbal tea, or other low-calorie beverages. This helps flush sugars out of your system.

Regular physical activity

Staying active is crucial for managing diabetes – and for maintaining overall health. Physical activity helps your body use insulin more efficiently and can lower blood sugar levels. As an avid runner myself, I love to talk about how older adults can incorporate exercise into your routine:

Start slowly: If you're new to exercise, start with low-impact activities like walking, swimming, or gentle yoga. Gradually increase the intensity and duration as you become more comfortable.
Find activities you enjoy: Whether it's dancing, gardening, or playing with your grandchildren, choose activities that you find enjoyable. This will make it easier to stick to your exercise routine.
Stay consistent: Aim for 150 minutes per week (for example, 30 minutes a day, 5 days a week) of moderate-intensity exercise, such as brisk walking. Consistency is key to reaping the benefits of physical activity.
Incorporate strength training: Building muscle through strength training exercises can help improve insulin sensitivity and overall strength. Use light weights or resistance bands to start.

Be sure to check in with your healthcare provider before starting any new exercise regimen!

Monitor your blood sugar

Regularly checking your blood sugar levels is essential for anyone who has diabetes. This helps you understand how different foods, activities, and medications affect your blood sugar. Here are some tips to ensure effective monitoring:

Use a glucometer: Invest in a reliable blood glucose monitor – covered under Medicare Part B with a prescription, over the counter at your local pharmacy, or at an online pharmacy – to check your blood sugar levels at home. Without insurance, a traditional glucose monitor can cost around $40 to $60, and diabetes test strips can cost around $100 a month. If you require insulin to control your blood sugar, you may be able to get a continuous glucose monitor, a wearable device that measures blood sugar levels in real time.
Keep a log: Record your blood sugar readings, along with any notes on your diet, exercise, and medications. This can help you and your healthcare provider identify patterns and make necessary adjustments.
Stay in touch with your healthcare provider: Regularly consult your healthcare provider to review your blood sugar levels and overall management plan. They can provide valuable insights and adjustments to your treatment plan.

Manage stress

Stress can negatively impact blood sugar levels, so it's important to find ways to manage it. Stay calm and focused by:

Practicing relaxation techniques: Techniques like deep breathing, meditation, and progressive muscle relaxation can help reduce stress and promote a sense of well-being.
Staying connected: Maintain strong social connections with family and friends. Join a support group for people with diabetes to share experiences, get recipe or exercise ideas, and gain support.
Engaging in hobbies: Pursue hobbies and activities that bring you joy and relaxation. Whether it's painting, reading, or playing cards, engaging in enjoyable activities can help reduce stress. Bonus points if these are physical activities like pickleball, yoga, walking, etc.!

Medication management

Always follow your healthcare provider’s instructions for prescribed medications and consult with him or her if you take any over the counter supplements or vitamins. And, make sure your provider has a complete list of all the medications you take, regardless of who prescribed them. You can proactively manage your medication regimen by:

- Following your prescription: Take your medications exactly as prescribed by your healthcare provider. Don't skip doses or make changes without consulting him or her. If a medication is too expensive or if you experience side effects, please let your healthcare provider know so that we can work to find a solution.
- Setting reminders: Use alarms or a medication organizer to remind you to take your medications on time.
- Understanding your medications: Learn about the medications you're taking, including potential side effects and how they interact with other medications or foods. Your healthcare provider can explain these to you, and this information is also typically packaged with prescriptions, both at the pharmacy or if you receive them by mail.

Managing Type 2 diabetes as an older adult involves a combination of healthy eating, regular physical activity, stress management, and proper medication use. By making a few simple lifestyle changes, you can take control of your health and lead a vibrant, active life. As I like to tell my patients, small steps can make a big difference! Stay proactive, seek support, and work closely with your healthcare provider to achieve the best possible outcomes.

Above all, stay healthy and take charge of your diabetes management!

Kathy Hill, NP, is a Primary Care Practitioner (PCP) at Patina, which provides healthcare, navigation and support exclusively for adults 65+ enrolled in traditional Medicare or participating Medicare Advantage plans in the Philadelphia 5-county area as well as Charlotte and the 10 surrounding counties in North and South Carolina. Kathy earned her MSN / NP, with a focus in geriatrics, from the University of Pennsylvania School of Nursing and has been a practicing clinician for more than 25 years. She is also a Certified Diabetes Care and Education Specialist. Read reviews from Kathy's patients on Healthgrades.

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