You’re over the age of 60, you don’t have diabetes but your blood glucose is…. creeping up?
The highest prevalence of type 2 diabetes (T2D) is in the over 60s age group, and about 700 people (of any age) are diagnosed with T2D every day in the UK. So naturally when people see their glucose creeping up, maybe as part of an annual GP check, people can be worried it means they’re developing T2D.
The first thing to know is that glucose creeps up as we age. In fact, 1/3 of the rise in the global prevalence of T2D is due to aging! (The other 2/3 is due to obesity). It rises slowly, so an annual rise does not necessarily mean you are developing or will ever develop T2D. If we all lived to 150 years old, most of us would develop T2D
The second thing to know is that exercise pushes glucose up – this is normal and healthy. In fact, the greater the volume of aerobic exercise a person does, the higher the HbA1c. So if you’re over the age of 60 and enjoy long cycle rides, long runs or otherwise, your slightly elevated glucose may well be due to a mixture of age and your exercise. I mention this because I see a lot of this kind of patient.
The third thing to remember is that even if you are developing T2D, the older you are upon diagnosis, the less the healthcare system cares*. The reason is that T2D causes damage to the tissues over time. So we have to take it more seriously* and manage it more aggressively if we can if a person develops T2D aged 30, because their body will be exposed to high blood glucose; high triglycerides and all the other risk factors in T2D over potentially 5 decades. When someone is older, there is less time for T2D to do any harm, but also at that point in life, other things (eg frailty) become a greater priority in managing.
What can you do practically
Some (gentle) weight loss if that works for you
Take a look at your other risk factors. You could also use this validated risk calculator from Diabetes UK.
If your waist circumference or BMI are elevated, the elevation in glucose may be due to this. You don’t necessarily need to lose a lot of weight to get control of your glucose, but even a small amount of weight loss will considerably reduce your risk of developing type 2 diabetes.
Waist circumference is really important because many people – especially as we age, gather weight around the middle. This can happen even if people are otherwise lean. Weight around the middle (or central adiposity as we call it) is a major risk factor for type 2 diabetes and cardiovascular disease generally. Here’s a good article on how to measure waist circumference and what the measurements mean.
Taking a look at dietary quality
Weight loss will help reduce internal fat (in fact liver fat is lost preferentially when people lose weight). However, there are other things you can do.
A higher protein intake will help lower liver fat, and it will also – alongside strength training – help preserve muscle mass.
More viscous/fermentable fibres, and generally including more whole, unprocessed plants in the diet may also help improve body composition. Here’s a specific diet sheet on this special kind of fibre.
Exercise
Exercise is incredibly important at this age. Any exercise, resistance or aerobic will improve your insulin sensitivity and lower your risk of developing T2D. More important than that – exercise will increase your strength, endurance, energy levels, and wellbeing. Strength-training in particular helps build and preserve muscle, and increase and maintain strength. You don’t need a personal trainer to do it, but many people find it helpful to get a session or two with one to teach them the exercises, which they can then do at home or at the gym in their own time.
Main messages
Firstly don’t worry too much – gradually rising or minimally elevated glucose is a normal part of aging – and can also be caused by exercise! Two, even if the rate of rise in glucose and your risk factors seem to indicate you may be “prediabetic”, there is a lot you can do to slow down or prevent type 2 diabetes and more importantly, improve your health anyway.
Here’s a diet sheet to give you some ideas of how to put it all together.
*I don’t know if these are the right words - the healthcare system should always care(!) - but its about risks and benefits - and in someone with type 2 diabetes aged 80, the risks of aggressively managing glucose outweigh the benefits for example.