Running head: SENIOR CENTER WRITE-UP 1

Senior Center Write-Up

Erika Bell

Westminster College of Nursing

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While providing screenings for the older adults, I noticed a few different health issues

that affected several members of the population we encountered. These chronic diseases seemed

to be very consistent with the age group and did not appear to discriminate between gender or

race. Not only did a large number of older adults have these chronic conditions, but there was

also a decent number of people we found who were at risk for developing them. A few examples

of these health problems include hypertension, diabetes mellitus, and peripheral arterial disease.

For the purposes of this paper, I have decided to focus on the prevalence of diabetes

mellitus (type 2) in older adults. I believe that this disease is important to focus on because of

how common it is in the older population. According to the American Diabetes Association,

more than 25% of the U.S. population over the age of 65 has diabetes (2012). In addition, elderly

people who develop type 2 diabetes may not present with symptoms, making it a “silent

disease.” Unmanaged type 2 diabetes can then lead to many other chronic diseases that could

have been prevented with proper blood glucose management.

Signs and symptoms of diabetes vary from person to person and are directly related to the

blood glucose level. Some of the fundamental manifestations include elevated thirst, increased

urination, and elevated appetite. These are often known as the “three Ps” in reference to their

medical terminology (polydipsia, polyuria, and polyphagia). Some other symptoms may include

vision changes, numbness or tingling in the hands and/or feet, and wounds that are slow to heal.

Insulin is an important component of diabetes’ development and treatment. Insulin is a

hormone that is normally made by the pancreas and secreted after a meal. Insulin aids in the

digestion and use of food that is eaten. Once food starts to be digested, sugar (glucose) from the

meal is absorbed into the bloodstream. Insulin facilitates the transport of glucose from the blood

into cells throughout the body. This occurs when insulin is able to bind with insulin-receptors
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located on cells. Once bound, glucose is able to enter cells. Once the glucose is in the cells,

glucose levels in the blood will significantly lower. This indicates that the cells in the body are

using the glucose to power different systems.

When a person has diabetes (specifically type 2), there are two main causes, both having

to do with insulin. The first complication is known as insulin resistance. This means that the

pancreas is still producing and secreting insulin properly. However, the insulin-receptor sites on

the cells are not as sensitive to the insulin, resulting in reduced cellular uptake of the glucose.

This means that the insulin is not working as well as it used to, which causes an increase in blood

glucose because it is unable to get into the cells properly.

The second cause of type 2 diabetes is due to decreased insulin secretion. This happens

when the pancreas is unable to secrete insulin normally. Decreased insulin levels would mean

that the body is unable to get all of the glucose from the blood into the cells. This would result in

elevated blood glucose levels.

Unmanaged diabetes can cause several secondary health concerns. These complications

are caused by the build up of glucose in the blood. Glucose can be very detrimental to cells

throughout the body. It can eventually lead to the blockage of small blood vessels that supply the

eyes. This condition is called diabetic retinopathy and can result in vision loss and even

blindness (Mayo Clinic, 2015).

In a similar fashion, high blood glucose levels can also damage the nerve fibers in the

hands and feet, resulting in a condition called diabetic neuropathy (Mayo Clinic, 2015). With this

complication, diabetics have reduced sensation to their extremities. This can lead to extreme

damage of the fingers and toes. This is caused by decreased pain sensation due to nerve damage.
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Several of these people are forced to undergo amputations of fingers and toes, which is

considered to be a severe consequence of poor glucose management.

Another serious complication of diabetes is the development of hypertension.

Hypertension is the term used for high blood pressure. This is considered to be a blood pressure

reading that is greater than 139/89. Diabetes can contribute to this condition because the

increased glucose in the blood can cause damage to the arteries of the body. This makes the

vasculature very susceptible to hardening, a disease known as atherosclerosis. The hardening of

the vessels restricts them from dilating, resulting in increased blood pressure. Hypertension can

have several different consequences that affect the entire body.

A final complication that can develop as a result of diabetes is kidney disease, which is

also called nephropathy. As with the previous complications I have mentioned, this is a result of

a buildup of glucose in the blood. This consequently results in the excretion of protein in the

urine. Protein is vital when it comes to the filtration of blood in the kidneys. Protein normally

stays in the blood and is not excreted in the urine. This protein can generate a type of pressure

that is needed to filter the waste products out of blood. However, when the protein is expelled in

the urine, it is unable to generate the pressure necessary to filter toxins out of the blood, resulting

in kidney damage.

Since all of the complications that were previously explained are quite severe, it is

important for people with diabetes to control their blood glucose levels properly. There are

several different types of medications available to help with the management of diabetic

symptoms that can result in unwanted conditions. However, there are also many factors that can

help manage type 2 diabetes without the use of medications that can potentially produce

unwanted side effects.

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One of the most effective ways to manage high blood sugar is exercise. Exercising

regularly can significantly decrease glucose levels in the blood. This is achieved because the

muscles use glucose as a source of energy when they are being used. Exercise can also increase

the sensitivity of insulin on the cells (American Diabetes Association, 2013). This would make

insulin more effective when it comes to transporting glucose from blood to cells. Exercising long

term has also been proven to reduce A1C levels. A1C is the level of glycosylated hemoglobin in

the blood.

Along with exercise, keeping a strict diet can also help to manage diabetes (American

Diabetes Association, 2013). It is essential for diabetics to track the amount of carbohydrates

they eat during the day. Carbs have the biggest impact on blood sugar levels and can raise

glucose levels significantly. It is also helpful for diabetics to know that some carbohydrates, like

those found in fruits and vegetables, are better for them than others. Fruits and vegetables have

lower amounts of carbs and also contain fiber.

Another important consideration for diabetics is sick days. When people get sick, their

bodies react as if they are under stress. This causes a release of cortisol, which increases blood

glucose levels. Cortisol also counteracts the effects of insulin, making it extremely hard to lower

high blood glucose. Diabetics should actively try to strengthen their immune systems and be

proactive by making a sick day plan with their providers.

One final way to help manage diabetes is to monitor alcohol consumption. Excessive

amounts of alcohol can be converted into fat, which could increase the risk of diabetic

ketoacidosis. Alcohol can also cause hypoglycemia. This happens because alcohol can decrease

the amount of sugar that is normally produced by the body (Hinkle, J. L., & Cheever, K. H., P.
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1424). Type 2 diabetics who are treated with insulin should be especially cognizant of glucose

levels when consuming alcohol.

When conducting glucose screenings at the senior center, I discovered a wide range of

results. Many of these results were considered abnormal. Specifically, I encountered several very

high glucose levels. Explaining these results to the clients proved to be challenging.

When interpreting these results, I started by giving the clients a brief description of what

blood sugar and insulin are. I explained how insulin is important when it comes to transporting

glucose from the blood into the cells. I then talked about how high blood sugar can indicate

diabetes, which is a problem that has to do with insulin.

The patients usually responded as though their high blood sugar wasn’t that important. I

wasn’t sure if I did not explain the concept well enough or if they just didn’t care about the

significance of the findings. Several of the clients with high glucose readings had already been

diagnosed with diabetes. These people usually had prescription medications that they simply

forgot to take.

For the clients with high glucose readings, my recommendations varied depending on

how high their levels were. If the glucose reading was only slightly elevated, I suggested that

they waited until their next scheduled appointment to bring it up with their provider. For the

people who had moderately high glucose levels, I advised them to schedule an appointment with

their providers. For those who had extremely high readings, I strongly suggested they should call

their providers directly. When speaking to those clients who had normal readings, I

recommended that they continue what they were doing and also to exercise regularly and to eat

healthy.
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References

American Diabetes Association. (2013, December 16). Blood glucose control and exercise.

Retrieved from http://www.diabetes.org/food-and-fitness/fitness/get-started-safely/blood-

glucose-control-and-exercise.html?referrer=https://www.google.com/

Hinkle, J. L., & Cheever, K. H. (n.d.). Brunner & suddarth's textbook of medical-surgical

nursing (13th ed.). Retrieved from https://coursepoint.vitalsource.com/#/books/

9781469863801/cfi/6/616!/4/2/2/2/16/14/84/4@0:69.4

Kirkman, S. (2012, December). Diabetes in older adults. Retrieved November 19, 2016, from

http://care.diabetesjournals.org/content/35/12/2650

Mayo Clinic Staff. (2015, February 24). Diabetic neuropathy. Retrieved November 17, 2016,

from http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/

definition/con-20033336

Mayo Clinic Staff. (2015, March 20). Diabetic retinopathy. Retrieved November 14, 2016, from

http://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/basics/causes/con-

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