Endocrine and Metabolic Problems and Nutrition in the Aged
Chapter 11
Diabetes Mellitus
• Type 1 diabetes mellitus– Lack of insulin production
• Type 2 diabetes mellitus– Resistance to insulin by the tissues leading to beta
cell failure
Diabetes Mellitus
• Epidemiology– Prevalence of T2DM = 180 million– 6th most frequent disease-specific cause of death
in the U.S.– T1DM
• Generally diagnosed in the younger population• 5% to 10% of all cases of DM
Diabetes Mellitus
Centers for Disease Control and Prevention. Prevalence of diagnosed diabetes by age in the United States, 1980–2005. Available at: http://www.cdc.gov/Diabetes/statistics/prev/national/figbyage.htm. Accessed February 12, 2008.
Diabetes Mellitus
• Types of Diabetes mellitus– Type 1
• Beta cell destruction or dysfunction• Usually leads to insulin deficiency
– Type 2• Occurs over time • B cells of pancreas produce less insulin as the
tissues develop resistance to insulin• Impaired insulin-mediated glucose uptake
Diabetes Mellitus
• Types of Diabetes– Third type of diabetes stems from a number of
possible causes– Gestational diabetes
• Risk Factors– Metabolic Syndrome
• Group of risk factors associated with insulin resistance
–Hypertension, dyslipidemia, hyperglycemia, central obesity
Diabetes Mellitus• Risk Factors
– Metabolic Syndrome (cont.)• A complex, poorly understood disorder• The obese older adult is at higher risk than
those at a normal weight• Easy screening method is waist circumference
– Sleep Disorders• Altered sleep patterns result in insulin
resistance and a decrease in carbohydrate tolerance
Diabetes Mellitus
• Prevention of Diabetes– Micro- and macro-vascular damage may have
already been done by the time of diagnosis
• Prediabetes– Recognize risk factors to plan an intervention to
avoid the onset of diabetes– Lifestyle changes– Antidiabetic pharmacotherapy
Diabetes Mellitus• Symptoms and Diagnosis of Diabetes
– Older adults with one risk factor should be screened for DM
– Hemoglobin A1C• Glycosylated hemoglobin
–Glucose in blood binds to Hgb–Stable over lifespan of the RBC–Value does not fluctuate like daily blood
glucose–Gives overview of blood sugars over a 3-
month period
Diabetes Mellitus
• Complications of Diabetes– Older adults often not diagnosed until
complications appear• Diabetes Management
– Lifestyle changes– Balance between tight glucose control,
management of comorbidities, and quality of life– Goals for blood lab values– Other components
Diabetes Mellitus• Diabetes Management (cont.)
– Collaborative health care team– Self-management, holistic approach– Diet and exercise
• Diet– Eat healthy, lose weight, and exercise regularly– Attain optimal metabolic outcomes– Maintain a healthy blood pressure and body
weight– Manage glucose control
Diabetes Mellitus
• Diet
Adapted from American Diabetes Association. Diabetes Food Pyramid. Available at: http://www.diabetes.org/food-nutrition-lifestyle/nutrition/meal-planning/diabetes-food-pyramid.jsp. Accessed July 6, 2009.
Diabetes Mellitus
• Diet (cont.)– Portion size– Use MyPyramid.gov to plan diet
Diabetes Mellitus
• Diet (cont.)– If overweight, moderate reduction in calories – If consume alcohol, do so in moderation– Less than 7% saturated fat in diet– RDA for Protein is 0.8 g per kilogram
Diabetes Mellitus
• Exercise– Individualized programs– Helps to reduce insulin resistance– Monitor BG to avoid hypoglycemia
• Insulin Injections– Subcutaneous
• Syringe or insulin pump, nasally inhaled insulin
Diabetes Mellitus
• Oral Medications– Sulfonylureas
• Enhances release of insulin from beta cells– Meglitinides
• Stimulates beta cells of pancreas to produce insulin
– Metformin• Decreases glucose absorption and improves
insulin sensitivity
Diabetes Mellitus
• Oral Medications (cont.)– Thiazolidinediones
• Lowers insulin resistance– Alpha-glucosidase
• Delays the digestion and absorption of carbohydrates
• Manage hypoglycemia– Eating 10 to 15 g of carbohydrates– Know signs and symptoms
A Summary of Diabetes Mellitus• Complex metabolic disorders• Most older adults have type 2 diabetes• Chronic and progressive disease• Requires a collaborative approach for
management• Four keys to successful management
– Diet– Exercise– Medications– Self-care strategies
The Endocrine System
National Institutes of Health, 2007.
The Endocrine System• Pituitary Gland and Hypothalamus
– Makes up the hypothalamic-pituitary axis– Increase or decrease
inhibitory/stimulating/trophic hormones– Hypothalamus
• Located at base of brain• Connected to the anterior pituitary and
posterior pituitary• Help control the trophic hormones• Produces appetite-reducing or stimulating
hormones
The Endocrine System
• Thyroid Glands– Thyroid diseases increase with age
• The Thyroid Gland and Its Dysfunctions– Hypothyroidism
• Results from a decrease in thyroid gland function
• Multiple causes• Signs and symptoms• Hypercholesterolemia
The Endocrine System
• The Thyroid Gland and Its Dysfunctions– Treatment
• Low-dose replacement of T4• Monitor lab values
The Endocrine System
• Hyperthyroidism– Increase in the function of the thyroid gland– Result of an overactive gland– Thyroxtoxicos
• Very severe form of hyperthyroidism– Grave’s disease
• Most common hyperthyroid state in older adults
Hyperthyroidism
• Epidemiology– Occurs more often in women than in men– More common in parts of the world with low
iodine availability– Clinical presentation
• Vague, nonspecific symptoms• Elevated T and T4 test and low TSH• See box 11-6 for general manifestations
– May be caused by certain foods– May result from autoimmune disease
Hyperthyroidism
• Epidemiology (cont.)– Apathetic hyperthyroidism
• Exclusively seen in frail older adults• Multiple clinical presentations
– Nutritional problems associated with hyperthyroidism• Hyponatremia, worsening of glucose tolerance,
milk hyperglycemia, anemia, and possibly osteoporosis
Hyperthyroidism
• Treatment– Medications– Radioiodine or surgery may be used– Surgery usually reserved for older patients with
large goiter or ophthalmapathy• Nodular Goiter and Thyroid Cancer in the
Older Adult– Common in adults older than age 70– Treatment: surgery, external radiation, and
chemotherapy
Hyperthyroidism
• Parathyroid Glands and Calcium Metabolism– Four glands– Secretes the parathyroid hormone
• Maintains serum calcium levels– Release of parathyroid hormone increases
between ages of 30 and 80– Calcitonin
• Inhibits the release of calcium– Vitamin D
• Facilitates calcium absorption
Hyperthyroidism
Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007. Reproduced with permission.
Hyperthyroidism
• Hyperparathyroidism– More common in women– Primarily the result of gland hyperplasia– Often milk and asymptomatic – Detected by serum calcium laboratory report– Multiple symptoms– Hypercalciuria and nephrolithiasis– Severe hypercalcemia– Treatment through surgery or pharmacological
treatment
Hyperthyroidism
• Hypocalcemia– Most common cause is inadequate intake of
dietary products, with decreased albumin, and vitamin D intake or activation
– Decrease exposure to sunlight and vitamin D synthesis by the skin
– Treated with calcitriol and oral calcium supplements, other medications, IV infusion of calcium
Osteoporosis
• Risk factors are known and identifiable• DEXA scans recommended for women 65
years and older• Postmenopausal osteoporosis
– Low bone mass– Micro-architectural deterioration of bone– Fragile bone– Heightened susceptibility to fracture
Osteoporosis
Visible Symptoms of Osteoporosis Due to Collapsed Vertebrae
Normal and Abnormal Bone in Osteoporosis
© Bill Aron/PhotoEdit © Dr. Michael Klein/Peter Arnold, Inc.
Osteoporosis
• Risk Factors/Prevention– Peak bone mass during ages 20 – 30– Prevention through adequate calcium and vitamin
D intake, enough sunlight, and weight-bearing exercises
– Hormone-replacement therapy– See Box 11-7 for risk and contributing factors for
osteoporosis
Osteoporosis• Treatment
– Vitamin D3 best supports bone health• Manufactured in skin following direct exposure
to sunlight• Food sources: fortified milk, egg yolks,
saltwater fish, liver, and supplements– Calcium intake recommendations
• 1,000 mg/day in ages 31 – 50 years• 1,200 mg/day for those older than 50
Osteoporosis• Medications
– Multiple medications used• Positive effects of estrogen• Reducing hip and vertebral fractures• New approach medications reduce survival of
osteoclasts and slow the rate of bone resorption
• Effect skeletal muscle tissues• Enhance bone mass and bone turnover• Help regulate secretion of calcitonin• Inhibit osteoclastic functions
Paget’s Disease
• Occurs in 1.3 of every 100 adults age 45 to 74• Changes bone and causes deformity and
increases tendency to fracture
Paget’s Disease: Normal and Abnormal Bone
Paget’s Disease
• Usually asymptomatic• Usually found by x-ray• Bones most commonly affected
– Skull, pelvis, spine, femur, and tibia
• Occasionally transforms to osteosarcoma
Adrenal Glands
• Aldosterone– Conserves sodium by increasing the activity of the
sodium pump of the epithelial cells
Water Metabolism
• Thirst perception diminishes with age• Edema
– Collection of excessive fluid in interstitial compartments
– May occur secondary to other conditions– Water intoxication– Aldosterone retains sodium, which retains water
Diseases of the Adrenal Cortex
• Antidiuretic hormone secretion tends to be excessive in aged individuals
• Hyponatremia may be caused by many of the illnesses that affect older adults
Adrenal Insufficiency: Addison’s disease
• A decrease in cortisol secretion• Most often caused by failure of the adrenal gland • Onset is primarily between ages of 30 and 50• Can be caused by autoimmune disorders, tumors,
infections, or suppression of the adrenal gland• Multiple symptoms• Management focuses on finding and treating the
cause and replace mineralcorticoids and glucocorticoids
Cushing’s Syndrome
• Exposure to excessive amounts of cortisol for a prolonged period of time
• Most common cause in older adults is exogenous corticoids
• Treatment – eliminating the excess cortisol
• Signs and Symptoms
Reproduced from An Introduction to Human Disease. 7th ed. Photos courtesy of Leonard V. Crowley, M.D., Century College.
Conclusion
• In conjunction with the nervous system, the endocrine system synthesizes and regulates hormones that send messages throughout the body.
• Nutrition plays a very important role in the management of the disorders discussed in this chapter.
Top Related