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Why Older People May Not Need to Watch Blood Sugar So Closely

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Why Older People May Not Need to Watch Blood Sugar So Closely

By now, Ora Larson recognizes what’s happening. “It feels like you’re shaking inside,” she said. “I’m speeded up. I’m anxious.” If someone asks whether she would like a salad for lunch, she doesn’t know how to respond.

She has had several such episodes this year, and they seem to be coming more frequently.

“She stares and gets a gray color and then she gets confused,” her daughter, Susan Larson, 61, said. “It’s really scary.”

Hypoglycemia occurs when levels of blood sugar, or glucose, fall too low; a reading below 70 milligrams per deciliter is an accepted definition. It can afflict anyone using glucose-lowering medications to control the condition.

But it occurs more frequently at advanced ages. “If you’ve been a diabetic for years, it’s likely you’ve experienced an episode,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco, who researches diabetes in older adults.

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The elder Ms. Larson, 85, has had Type 2 diabetes for decades. Now her endocrinologist and her primary care doctor worry that hypoglycemia may cause falls, broken bones, heart arrhythmias and cognitive damage.

Both have advised her to let her hemoglobin A1c, a measure of average blood glucose over several months, rise past 7 percent. “They say, ‘Don’t worry too much about the highs — we want to prevent the lows,’” the younger Ms. Larson said.

But her mother has spent 35 years working to maintain an A1c below 7 percent — a common recommendation, the goal people sing and dance about in pharma commercials.

She faithfully injects her prescribed drug, Victoza, about three times a week and watches her diet. She’s the oldest member of the Aqua for Arthritis class at a local pool in St. Paul, Minn.

So when her doctors recommended a higher A1c, she resisted. “I think it’s a bunch of hooey,” she said. “It didn’t make sense to me.”

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“She got a lot of encouragement and recognition from her physicians for controlling her diabetes, staying on top of it,” her daughter explained. “They always praised her ‘tight control.’”

“For someone who’s been so compliant all these years, it’s like they changed the rules.”

In fact, they have.

More than a decade ago, the American Geriatrics Society called for a hemoglobin A1c of 7.5 to 8 for most older adults with diabetes, and 8 to 9 percent for those contending with multiple chronic illnesses and limited life expectancy. (The elder Ms. Larson has multiple sclerosis and hypertension.)

Other medical societies and advocacy groups, including the American Diabetes Association and the Endocrine Society, have also revised their guidelines upward for older patients.

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Relaxing aggressive treatment can involve stopping a drug, lowering a dose or switching to another medication — an approach called de-intensification.

The advent of effective new diabetes drugs — GLP-1 receptor agonists (like Ozempic) and SGLT2 inhibitors (like Jardiance) — has further altered the landscape. Some patients can substitute these safer medications for risky older ones.

But the new drugs can also complicate decisions, because not all older patients can switch — and for those who can, insurance companies may balk at the new medications’ high price tags and deny coverage.

So de-intensification is proceeding, but too gradually.

A 2021 study of Medicare beneficiaries with diabetes, for instance, looked at patients who had gone to an emergency room or been hospitalized because of hypoglycemia. Fewer than half had their medication regimens de-intensified within 100 days.

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“Nursing-home residents are the ones that get into trouble,” said Dr. Joseph Ouslander, a geriatrician at Florida Atlantic University and the editor in chief of The Journal of the American Geriatrics Society.

Another 2021 study, of Ontario nursing homes, found that over half of residents taking drugs for Type 2 diabetes had A1c levels below 7 percent. Those with the greatest cognitive impairment were being treated most aggressively.

Dr. Ouslander has calculated, based on a national study, that roughly 40,000 emergency room visits annually resulted from overtreatment of diabetes in older adults from 2007 to 2011. He thinks the numbers are likely to be much higher now.

A brief primer: Diabetes can cause such grievous complications — heart attacks, stroke, vision and hearing loss, chronic kidney disease, amputations — that so-called strict glycemic control makes sense in young adulthood and middle age.

But tight control, like every medical treatment, involves a period of time before paying off in improved health. With diabetes, it’s a long time, probably eight to 10 years.

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Older people already contending with a variety of health problems may not live long enough to benefit from tight control any longer. “It was really important when you were 50,” said Dr. Lee. “Now, it’s less important.”

Older diabetics don’t always welcome this news. “I thought they’d be happy,” Dr. Lee said, but they push back. “It’s almost like I’m trying to take something away from them,” he added.

The risk that tight control will also set off hypoglycemia increases as patients age.

It can make people sweaty, panicky, fatigued. When hypoglycemia is severe, “people can lose consciousness,” said Dr. Scott Pilla, an internist and diabetes researcher at Johns Hopkins. “They can become confused. If they’re driving, they could have an accident.”

Even milder hypoglycemic events “can become a quality-of-life issue if they’re happening frequently,” causing anxiety in patients and possibly leading them to limit their activities, he added.

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Experts point to two kinds of older drugs particularly implicated in hypoglycemia: insulin and sulfonylureas like glyburide, glipizide and glimepiride.

For people with Type 1 diabetes, whose bodies cannot produce insulin, injections of the hormone remain essential. But the medication is “widely recognized as a dangerous drug” because of its hypoglycemia risk and should be carefully monitored, Dr. Lee said.

The sulfonylureas, he added, “are becoming less and less used” because, while less risky than insulin, they also cause hypoglycemia.

The great majority of older adults with diabetes have Type 2, which gives them more options. They can supplement the commonly prescribed drug metformin with the newer GLP-1 and SGLT2 drugs, which also have cardiac and kidney benefits. If necessary, they can add insulin to their regimens.

Among the new drugs’ more popular consequences, however, is weight loss.

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“For older people, if they’re frail and not very active, we don’t want them losing weight,” Dr. Pilla pointed out. And both metformin and the GLP-1 and SGLT-2 medications can have gastrointestinal or genitourinary side effects.

For 15 years, Dan Marsh, 69, an accountant in Media, Pa., has treated his Type 2 diabetes by injecting two forms of insulin daily. When he takes too much, he said, he wakes up at night with “the damn lows,” and needs to eat and take glucose tablets.

Yet his A1c remains high, and last year doctors amputated part of a toe. Because he takes many other medications for a variety of conditions, he and his doctor have decided not to try different diabetes drugs.

“I know there’s other stuff, but we haven’t gone that way,” Mr. Marsh said.

With all the new options, including continuous glucose monitors, “figuring out the optimal treatment is becoming more and more difficult,” Dr. Pilla said.

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Bottom line, though, “older people overestimate the benefit of blood-sugar lowering and underestimate the risk of their medications,” he said. Often, their doctors haven’t explained how the trade-offs shift with older age and accumulating health problems.

Ora Larson, who carries chewable glucose tablets with her in case of hypoglycemia (fruit juice and candy bars are also popular antidotes), intends to talk over her diabetes treatment with her doctors.

It’s a good idea. “The biggest risk factor for severe hypoglycemia is having had hypoglycemia before,” Dr. Lee said.

“If you have one episode, it should be thought of as a warning signal. It’s incumbent on your doctor to figure out, Why did this happen? What can we do so your blood sugar doesn’t go dangerously low?”

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5 Surprising Ozempic Side Effects Doctors Are Finally Revealing (Like Back Pain and Hair Loss)

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5 Surprising Ozempic Side Effects Doctors Are Finally Revealing (Like Back Pain and Hair Loss)


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Relationship coach blames Oprah for pushing family estrangement ‘for decades’

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Relationship coach blames Oprah for pushing family estrangement ‘for decades’

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Oprah Winfrey is shining a light on family estrangement, which she calls “one of the fastest-growing cultural shifts of our time” — but one expert says the media mogul helped fuel that very culture.

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“A Cornell University study now shows that almost one-third of Americans are actively estranged from a family member,” Winfrey said on a recent episode of “The Oprah Podcast,” referring to adult children going “no-contact” with parents, siblings or entire family systems.

Winfrey said the trend is a “silent epidemic” that can be especially relevant during the holidays.

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But family and relationship coach Tania Khazaal, who focuses on fighting “cutoff culture,” took to social media to criticize Winfrey for acting as if the estrangement crisis appeared “out of thin air.”

“Now Oprah is shocked by the aftermath of estrangement, after being one of the biggest voices pushing it for decades,” Canada-based Khazaal said in an Instagram video, which drew more than 27,000 likes and 3,000 comments.

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Oprah Winfrey recently discussed what she called a “silent epidemic” of family estrangement on her podcast. (Theo Wargo/Getty Images)

Khazaal claimed that Winfrey’s messaging started in the 1990s and has contributed to a cultural shift where walking away became the first resort, not the last.

According to the relationship coach, millennials, some of whom grew up watching Oprah, are the leading demographic cutting off family members — and even if it wasn’t intentional, “the effect has absolutely been harmful,” Khazaal told Fox News Digital.

FAMILY BREAKUPS OVER POLITICS MAY HURT MORE THAN YOU THINK, EXPERT SAYS

The coach, who has her own history with estrangement, questioned why Winfrey is now treating the issue as a surprising crisis.

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“Now she hosts a discussion with estranged parents and estranged kids, speaking on estrangement like it’s some hidden, sudden, heartbreaking epidemic that she had no hand in,” she said in her video.

Nearly one-third of Americans are estranged from a family member, research shows. (iStock)

Khazaal said she believes discussions about estrangement are necessary, but insists that people shouldn’t “rewrite history.”

“Estrangement isn’t entertainment or a trending conversation piece,” she added. “It’s real families, real grief, parents dying without hearing their child’s voice.”

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Winfrey reportedly responded in the comments, writing, “Happy to have a conversation about it — but not on a reel. Will have my producer contact you if you’re interested.” But the comment was later deleted due to the backlash it received, Khazaal told Fox News Digital.

“I would still be open to that discussion,” Khazaal said. “The first thing I’d want her to understand is simple: Setting aside cases of abuse or danger, the family unit is the most sacred structure we have.” 

Experts emphasize that estrangement should be a last resort. (iStock)

“When children lose their sense of belonging at home, they search for it in the outside world,” she added. “That’s contributing to the emotional fragility we’re seeing today.”

Her critique ignited a debate online, with some social media users saying Khazaal is voicing a long-overdue concern.

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“The first time I heard, ‘You can love them from a distance’ was from Oprah … in the ’90s,” one woman said.

My son estranged himself from us for five years,” one mother commented. “The pain, hurt and damage never goes away.”

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Others, however, argued that Winfrey’s podcast episode was empathetic and that estrangement shouldn’t be oversimplified.

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Mental health experts say the conversation around estrangement is more complex than any single celebrity influence, and reflects broader cultural shifts.

Experts say today’s focus on boundaries and emotional well-being has reshaped family expectations. (iStock)

In the episode with Winfrey, Joshua Coleman, a California-based psychologist, said, “The old days of ‘honor thy mother and thy father,’ ‘respect thy elders’ and ‘family is forever’ has given way to much more of an emphasis on personal happiness, personal growth, my identity, my political beliefs, my mental health.” 

Coleman noted that therapists sometimes become “detachment brokers” by unintentionally green-lighting estrangement.

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Jillian Amodio, a licensed master’s social worker at the Maryland-based Waypoint Wellness Center, told Fox News Digital that while public figures like Winfrey help normalize these conversations, estrangement might just be a more openly discussed topic now.

“Estrangement used to be handled privately and quietly,” she said.

Winfrey’s take on family estrangement is prompting a broader discussion amid the holiday season. (iStock)

But even strained relationships can be fixed with the right support, experts say.

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Susan Foosness, a North Carolina-based clinical director of patient programs at Rula Health, said families can strengthen their relationships by working with a mental health professional to improve communication, learn healthier conflict-resolution skills, and build trust and empathy through quality time together.

“No family is perfect,” Foosness told Fox News Digital.

Khazaal agreed, saying, “Parents need to learn how to listen without slipping into justification, and children need help speaking about their pain without defaulting to blame or avoidance.”

Fox News Digital reached out to Winfrey for comment.

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Major measles outbreak leads to hundreds quarantined in US county, officials say

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Major measles outbreak leads to hundreds quarantined in US county, officials say

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South Carolina is facing a major measles outbreak, resulting in the quarantine of hundreds of residents.

The South Carolina Department of Health (DPH) reported in a media briefing on Wednesday that the current number of measles cases has reached 111 as part of the current Spartanburg County outbreak.

DPH first reported a measles outbreak in the Upstate region on Oct. 2.

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The health department confirmed that 254 people are currently in quarantine and 16 are in isolation to prevent further spread.

The health department confirmed that 254 people are currently in quarantine in the upstate region. (Getty Images)

“This significant jump in cases is unfortunate,” a DPH spokesperson commented on the outbreak.

Public exposure was identified at Inman Intermediate School, with 43 of their students in quarantine.

“This significant jump in cases is unfortunate.”

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Eight other intermediate and middle schools in the area are also reportedly undergoing quarantine. The DPH said multiple students have had to quarantine twice due to repeat exposure.

“Vaccination continues to be the best way to prevent the disruption that measles is causing to people’s education, to employment and other factors in people’s lives and our communities,” the spokesperson said.

“This significant jump in cases is unfortunate,” a DPH spokesperson commented on the current outbreak. (iStock)

Out of the 111 confirmed cases, 105 were unvaccinated. Receiving a vaccination within 72 hours has been shown to prevent measles infection, the DPH spokesperson noted. 

Some cases are related to travel exposure, while others are from an unknown source, suggesting that measles is circulating in the community, the DPH noted.

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Connecticut has also reported its first measles case in four years, according to the Connecticut Department of Public Health.

The department confirmed on Thursday that an unvaccinated child in Fairfield County, under the age of 10, was diagnosed with measles after recently traveling internationally.

“Vaccination continues to be the best way to prevent the disruption that measles is causing,” a DPH spokesperson said. (iStock)

The child began to show symptoms several days later, including a runny nose, cough, congestion, fever and a rash starting at the head and spreading to the rest of the body.

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The Connecticut DPH noted that measles is “highly contagious” and can spread quickly through the air via coughing or sneezing. The CDC has estimated that nine out of 10 unvaccinated individuals who encounter an infected person will develop the measles virus.

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According to the International Vaccine Access Center, more than 1,800 cases of measles have been reported in 2025, which is the most since the U.S. declared the virus eliminated in 2000. It is also the most cases recorded in three decades.

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“The single best way to protect your children and yourself from measles is to be vaccinated,” DPH Commissioner Manisha Juthani, M.D., wrote in a statement. “One dose of measles vaccine is about 93% effective, while two doses are about 97% effective.”

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