Foods containing starchy carbohydrate such as bread, potatoes, cereals, rice and pasta
should be encouraged and form the main part of every meal. In particular high fibre
foods such as granary bread and wholegrain cereals help to prevent constipation. The
fibre in porridge, peas, beans, lentils, fruit and vegetables also helps to improve blood
glucose control.
From my point of view,I think that the statement is back to front.
1)The fibre in porridge etc helps to improve blood glucose control
2) Higher fibre foods such as granary bread etc help to prevent constipation
3) Some foods containing carbohydrates, with a large proportion from the lower part of the glycaemic index should be served at every meal.
Which ,of course means that by relaxing the targets ,the elderly,who already probably have compromised blood flow etc will succumb even more quickly to diabetic complications!!
Are our elders not worth more than this to us?? Why should we not strive for good control in the elderly as well as younger people?
the elderly are a different population with different needs and responses to medication etc It may not necessarily be a good idea to atempt to impose tight control.
This paper on the clinical management of diabetes in the elderly describes some of the differences and diffculties .
http://clinical.diabetesjournals.org/cgi/content/full/19/4/172 Steve Edelman is well known for being an advocate of self empowerment for people with diabetes.
Some of the problems:
The elderly are more likely to have hypos. Elderly patients also often have hypo unawareness , they also may not be able to respond quickly to a hypo.
'ideal HbA1c target of <7% may be difficult to achieve in the elderly... research lacking on benefit of tight control (>80 years of age).
' Restricting caloric intake in long-term care patients should be done with much caution. Many already have insufficient caloric intake because of confusion, dysphagia, and diminished appetite.
Medications have differing effects on the elderly and some may be contraindicated because of other co existing problems. For example metformin should not be given if the kidney function is diminished(as it often is in the elderly) and can also cause anorexia and weight loss. There are pros and cons with all the options.
Coexisting health problems, such as dementia or psychiatric illnesses, may require a simplified approach to diabetes care
The paper also says that complications occur at higher rates in the elderly.
It concludes that a multidiscipinary approach ( doctor, pharmacist, social worker dietitian,) is necessary. I '
I agree with that, unfortunately, guidelines often seem to miss out the individual. the elderly person must if posssible have some say in the matter and there answer may not always be the one that we think is best for them. Recently my 80 year old father (who's sometimes a bit of a hypochondriac) wondered if he might have diabetes, would I test him? I asked him would he change his diet if he was. No, he would carry on just the same. (actually I asked the GP to do a fasting test and it came back fine, in spite of the fact that my father eats lots of white bread, cakes, potatoes , meat, the odd banana and almost no veg )