Diabetes is a serious disease at any age. In recent years, type 2 diabetes has reached epidemic levels among younger people — adults in their 20s and 30s, teenagers, even children — in nearly every region of the world, with Asia being especially hard hit.

Despite the trend in younger groups, the largest portion of the 400 million diabetes continues to have its greatest impact among adults aged 65 and older, with countries like the U.S. reporting diabetes rates of 25 percent for the 65-and-older population.

The graying of the world’s population is driving type 2 diabetes rates higher among the elderly, who face a unique set of challenges in managing this chronic medical condition.

Here are four serious challenges for elderly patients with diabetes.

1. Drug interactions pose risks

The older we get, the more likely we are to be diagnosed with one or more chronic diseases. Compared to younger age groups, a much higher percentage of elderly patients with diabetes have at least one other chronic condition — called co-morbidities — such as coronary heart disease, hypertension, and osteoarthritis.

Dealing with multiple diseases usually involves taking multiple drugs prescribed by different doctors. Each medication can affect the way other drugs work and how long they stay in the body; interactions can increase the blood level of some drugs, causing toxicity, or lower the level of other drugs, rendering them ineffective. In addition to interactions between drugs, foods and nutrients can also produce adverse drug interactions , as can certain medical conditions — diseases of the liver and kidneys can slow the body’s rate of drug metabolism . Aging itself is also correlated with slower drug metabolization.

You can take steps to reduce drug interaction risk by:

• having clear instructions for each medication, including prescribed dosage amount, frequency, timing e.g. with meals, on an empty stomach, with a specific drink, etc.;
• filling all prescriptions at the same pharmacy;
• informing each doctor about drugs prescribed by other doctors, dosage changes, and over-the-counter medicine usage; and
• closely monitoring your reaction when taking any new drugs.

2. Exercise is still important

Effectively managing diabetes requires a vigilant approach to diet and nutrition, physical activity, monitoring blood sugar levels , and taking medication as prescribed. The benefits of exercise can be as powerful for older diabetic patients as they are for younger patients. Alternating between aerobic exercise and resistance/strength training at moderate intensity is generally safe for older adults and makes it easier to control blood sugar levels and body weight.

In addition to lowering blood pressure , exercise makes muscles more sensitive to insulin , enabling them to absorb more glucose from the blood — in some cases reducing a patient’s need for medication to lower blood sugar levels.

A number of alternative exercise methods have been shown to benefit patients with mobility limitations caused by arthritis or other conditions. Talk to your doctor about options such as yoga for seniors, aquatic aerobics, stationary biking, and chair-based exercise.

3. Be vigilant about depression

At first glance, diabetes and depression don’t appear to have much in common, but the truth is, the two diseases tend to go “hand in hand” and in combination, they represent a major health threat. Regardless of age, having type 2 diabetes can increase the risk of depression by up to two to three times, compared to people without diabetes.

When both diabetes and depression are present together, a patient’s quality of life can suffer greatly. Controlling diabetes requires motivation, energy, attention to detail, and exercise and physical activity — and depression can overpower these healthy habits, reducing motivation, replacing energy with fatigue, altering eating habits, and impairing concentration and memory function.

Nearly one-third of adults aged 65 and older suffer from depression, regardless of whether they have diabetes. It is a serious but treatable medical condition that still carries a social stigma and cultural baggage, particularly among older people, which makes those suffering from it reluctant to discuss it with family members or health professionals. The good news is, research has clearly shown that elderly patients who receive treatment for both diabetes and depression are better able to control their diabetes compared to those who do not receive treatment for both conditions. So be watchful for possible symptoms of depression (sense of despair lasting at least two weeks, difficulty sleeping, change in appetite, significant weight gain or loss, fatigue, or lack of energy) and tell your doctor and those in your social circle about your symptoms.

4. Protect your vision

Aging has an impact on most people’s eyesight, but diabetes can lead to the more serious vision threat known as diabetic retinopathy (DR) — the most common cause of blindness in diabetics and a leading microvascular complication among elderly patients.

Diabetic retinopathy damages the retina , the layer of nerves which lines the back of the eye-ball. DR is a by-product of the cumulative long-term inflammation damage caused by years of living with elevated blood sugar levels. A patient’s DR risk increases the longer he or she has diabetes. The disease is most prevalent among patients with at least 20 years of diabetes history.

• DR is a disease that damages the retina, the layer of nerves which lines the back of the eye-ball. DR can lead to vision impairment and total blindness;
• Symptoms may not be noticeable during DR’s most treatable early stages. Changes in vision indicate severe eye damage has already occurred and likely to worsen;
• There are a number of steps you can take to reduce your DR risk. First and foremost is to keep blood sugar levels under control, maintain a healthy blood pressure , avoid smoking, and limit alcohol consumption. These steps may prevent DR, reduce its severity, or slow its progression;
• Diabetic retinopathy is not curable, but treatments can effectively prevent loss of vision when DR is diagnosed earlier, before the retina has suffered serious damage;
• The only way to diagnose DR is with a dilated eye exam, so having yearly eye exams can mean the difference between vision and blindness.