Other factors such as polypharmacy, malnutrition or erratic food intake, and co-existing chronic illnesses necessitate caution and careful supervision of the elderly while being treated with these medications. In addition, the elderly are more susceptible to hypoglycemia with neuroglycopenic symptoms predominating. Macrovascular complications are the major source of morbidity and mortality among the elderly with diabetes. All risk factors for atherosclerosis should be addressed including smoking, hypertension, obesity and physical inactivity. Aggressive treatment of hyperlipidemia is recommended though still somewhat controversial.
Microvascular complications including retinopathy, nephropathy, and neuropathy can also occur.
Older patients with diabetes are at increased risk of blindness from cataracts, macular degeneration and glaucoma in comparison with younger patients with diabetes. The age and duration of diabetes are important determinants of the prevalence of nephropathy. Diabetes remains the leading cause of kidney failure leading to dialysis. The elderly are particularly prone to radiographic dye-induced acute tubular necrosis. Elderly patients also appear to be more susceptible to peripheral neuropathy.