Hi,

Thanks for writing in.
Diabetes have basic two types- type I and type II. Type II occurs in age group older than 40 yrs. It is not insulin dependent , medications alone or in combination with insulin are enough to treat.

Let me brief first about need of insulin in glucose metabolism so that you will understand how diabetes occurs elderly. Not all elderly people are affected with DM.

Following the consumption of food, carbohydrates are broken down into glucose molecules in the gut. Glucose is absorbed into the bloodstream elevating blood glucose levels. This rise in glycemia stimulates the secretion of insulin from the beta cells of the pancreas. Insulin is needed by most cells to allow glucose entry.

The increased insulin secretion from the pancreas and the subsequent cellular utilization of glucose results in lowered of blood glucose levels. Lower glucose levels then result in decreased insulin secretion.

3 mechanism are responsible for diabetes in old- (1) peripheral resistance to insulin, especially in muscle cells; (2) increased production of glucose by the liver; and, (3) altered pancreatic insulin secretion.

Increased tissue resistance to insulin generally occurs first and is eventually followed by impaired insulin secretion. The pancreas produces insulin, yet insulin resistance prevents its proper use at the cellular level. Glucose cannot enter target cells and accumulates in the bloodstream, resulting in hyperglycemia and diabetes.
Obesity contributes greatly to insulin resistance.
Unfortunately, the insidious nature of the disease allows prolonged periods of hyperglycemia to begin exerting negative effects on major organ systems. By the time many type 2 diabetic patients are diagnosed, diabetic complications have already begun.

I hope I have answered your query. In case of any doubt, I shall be happy to help you.
Best regards,
Dr. Neelam.

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