July 9, 2025

Pre-Diabetes and Type 2 Diabetes in the Elderly:
What You Need to Know

As we age, our risk for developing chronic health conditions increases—including pre-diabetes and type 2 diabetes. In fact, nearly 1 in 4 Americans over the age of 65 (16.5 million seniors, 29.2% of the population) has diabetes, and many more have pre-diabetes without even knowing it. Early recognition and proper management are key to maintaining independence, avoiding complications and improving quality of life in older adults.

What Is Pre-Diabetes?

Pre-diabetes is a condition where blood glucose levels are higher than normal, but not yet high enough to be classified as type 2 diabetes. It's a warning sign—and an opportunity. With lifestyle changes, many seniors can prevent or delay the progression to diabetes.

Why Older Adults Are at Higher Risk

Several age-related changes contribute to the risk of pre-diabetes and type 2 diabetes in older adults:

• Decreased physical activity due to joint problems, chronic conditions or fatigue
• Loss of muscle mass, which helps regulate blood sugar
• Weight gain or shifts in fat distribution
• Changes in how the body processes insulin
• Long-term use of medications, such as steroids or diuretics that affect blood glucose

Other risk factors include a family history of diabetes, high blood pressure, high cholesterol and a history of gestational diabetes in women.

Common Symptoms in Older Adults

Recognizing symptoms of diabetes in the elderly can be challenging, as they may be mistaken for normal aging. Watch for:

• Unexplained fatigue or weakness
• Increased thirst and frequent urination
• Blurry vision
• Slow-healing wounds or frequent infections
• Confusion, irritability or changes in behavior (can signal high or low blood sugar)
• Unintentional weight loss

Because symptoms may be subtle or overlap with other conditions, regular screenings are important—especially if you have risk factors.

Complications of Diabetes in the Elderly

When not well-managed, diabetes can lead to serious complications that may impact an older adult’s ability to live independently:

• Heart disease and stroke: Diabetes doubles the risk.
• Kidney disease: Common in long-term diabetes cases.
• Vision problems: Including diabetic retinopathy and increased risk of blindness.
• Nerve damage: Leading to pain, numbness and increased risk of falls.
• Cognitive decline: Poor blood sugar control is linked to dementia.
• Foot problems and amputations: Due to poor circulation and infection.

Managing Diabetes in Older Adults

Managing diabetes in the elderly requires a personalized approach that takes into account their overall health, lifestyle and other chronic conditions.

1. Healthy Eating

• Focus on whole foods: fruits, vegetables, lean proteins and whole grains
• Limit processed foods and sugary snacks
• Maintain a regular eating schedule to help stabilize blood sugar

2. Physical Activity

• Aim for 150 minutes of moderate activity per week (as tolerated)
• Walking, water aerobics, chair exercises and yoga are great options
• Physical activity improves insulin sensitivity and helps maintain a healthy weight

3. Medication Management

• Work closely with a healthcare provider to manage blood sugar safely
• Older adults may be more sensitive to some diabetes medications
• Avoid low blood sugar episodes (hypoglycemia), which are more dangerous in seniors

4. Routine Monitoring

• Regular blood sugar checks, even if using lifestyle management alone
• Monitor blood pressure, cholesterol and kidney function

5. Preventive Care

• Annual eye exams and foot exams
• Regular A1C testing (every 3-6 months depending on control)
• Flu, pneumonia and shingles vaccinations to prevent infections

A Community Effort

At Eastern North Carolina Prevent Diabetes, we believe it's never too late to take steps toward better health. If you or a loved one is over 60 and concerned about blood sugar levels or diabetes risk, we encourage you to talk with your healthcare provider and ask about pre-diabetes screening.

Programs like Diabetes Prevention Programs (DPPs) offer practical support and guidance to help older adults make healthy lifestyle changes. Whether you're newly diagnosed or trying to avoid diabetes altogether, support and education make a difference.

You’re not alone—and prevention is possible. With the right tools and support, older adults in Eastern North Carolina can take charge of their health and prevent diabetes-related complications.

Sources:

American Diabetes Association
National Institute on Aging
CDC
UpToDate
National Library of Medicine