[Current principles of therapy of diabetes mellitus in old age]

The criteria for the diagnosis of diabetes are the same in all age groups. The main reason for a deterioration of glucose tolerance with age is insulin resistance, primarily concerning glucose uptake of skeletal muscle. The decision of if and how diabetes is treated in old people is a highly individual one depending on the patient's general condition and life circumstances. Acute symptoms are poorly characteristic and can be mistaken as complaints of old age, thus they play the most important role in deciding therapy. Diet is the most important role in deciding therapy. Diet is the most important therapy and the only therapeutic aspect without side-effects. The patients habits must be known before prescribing a practical diet. Besides general principles of a diabetic diet, hyperlipidemia and hypertension, and also deficiencies in nutrients must be taken into account. By reducing insulin resistance, exercise training can excellently support dietary therapy. Additional drug therapy should certainly be started if acute symptoms persist with proper diet, or if fasting glucose concentrations in plasma exceed 200 mg/dl. Acarbose, metformin, sulfonylureas, and insulin are the drugs available, of which mechanisms of action, applications, and side-effects are described. In the order given the efficacy of these drugs as well as the risk of dangerous side-effects increases. If sulfonylureas or insulins are applied for treatment the risks of hypoglycemia must be explained to the patient and his family, and must be prevented by all means. Finally, the importance of treating the diseases accompanying and following diabetes is stressed.