Health
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.
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.”
“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.
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.
“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.
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.
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.
“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.
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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What if your New Year’s resolution could fit inside a tote bag? Social media users are trying the “analog bag” trend, replacing phones with offline activities.
The trend is widely credited to TikTok creator Sierra Campbell, who posted about her own analog bag — containing a crossword book, portable watercolor set, Polaroid camera, planner and knitting supplies — and encouraged followers to make their own.
Her video prompted many others to share their own versions, with items like magazines, decks of cards, paints, needlepoint and puzzle books.
CREATIVE HOBBIES KEEP THE BRAIN YOUNG, STUDY FINDS — HERE ARE THE BEST ONES TO PURSUE
“I made a bag of non-digital activities to occupy my hands instead of the phone,” said Campbell, adding that the practice has significantly cut her screen time and filled her life with “creative and communal pursuits that don’t include doom-scrolling.”
“I created the analog bag after learning the only way to change a habit is to replace it with another,” she told Fox News Digital.
Social media users are trying the “analog bag” trend, replacing phones with offline activities like cameras, notebooks and magazines. (Fox News Digital)
The science of healthier habits
Research on habit formation supports the idea of the analog bag, according to Dr. Daniel Amen, a California-based psychiatrist and founder of Amen Clinics.
“Your brain is a creature of habit,” Amen said during an interview with Fox News Digital. “Neurons that fire together wire together, meaning that every time you repeat a behavior, whether it’s good or bad, you strengthen the neural pathways that make it easier to do it again.”
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Studies show that habits are automatic responses to specific cues — such as boredom, stress or idle time — that typically deliver some kind of reward, according to the doctor. When no alternative behavior is available, people tend to fall back on the same routine, often without realizing it.
Research suggests that replacing an old habit with a new one tied to the same cue is more effective than trying to suppress the behavior altogether.
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“[When] cutting out coffee — you need to have another drink to grab for, not just quit cold turkey. It’s how the pathways in our brains work,” Campbell said.
By substituting a different routine that still provides stimulation and engagement, people can gradually weaken the original habit and build a new automatic response.
Substituting another activity instead of scrolling on your phone can help quell the impulse to reach for it. (iStock)
“Simply stopping a behavior is very challenging,” Amen said. “Replacing one habit with something that is better for your brain is much easier. That’s how lasting change happens, one step at a time.”
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If alternatives are within arm’s reach, people will be more likely to use them, the doctor said. “Your brain does much better with small, simple actions than big, vague intentions.”
Instead of saying, “I’ll stop scrolling today,” the doctor recommends choosing a small habit you can do in a few moments in specific situations, like knitting 10 rows of a scarf on your commute or reading a few pages of a book while waiting at the doctor’s office.
“If alternatives are within arm’s reach, you’re more likely to use them,” a brain doctor said. “Your brain does much better with small, simple actions than big, vague intentions.” (iStock)
Campbell shared her own examples of how to use an analog bag. At a coffee shop with friends, she said, she might pull out a crossword puzzle and ask others to help with answers when the conversation lulls.
Instead of taking dozens of photos on her phone, she uses an instant camera, which limits shots and encourages more intentional moments.
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In casual outdoor settings, such as a park or winery, she brings a small watercolor set for a quick creative outlet.
“It’s brought so much joy,” Campbell said of the analog bag trend, “seeing how it resonates with so many.”
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A deadly, drug-resistant fungus already spreading rapidly through U.S. hospitals is becoming even more threatening worldwide, though there may be hope for new treatments, according to a new scientific review.
Candida auris (C. auris), often described as a “superbug fungus,” is spreading globally and increasingly resisting human immune systems, Hackensack Meridian Center for Discovery and Innovation (CDI) researchers said in a review published in early December.
The findings reinforce prior CDC warnings that have labeled C. auris an “urgent antimicrobial threat” — the first fungal pathogen to receive that designation — as U.S. cases have surged, particularly in hospitals and long-term care centers.
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Approximately 7,000 cases were identified across dozens of U.S. states in 2025, according to the CDC, and it has reportedly been identified in at least 60 countries.
Candida auris is a drug-resistant fungus spreading in hospitals worldwide. (Nicolas Armer/Picture Alliance via Getty Images)
The review, published in Microbiology and Molecular Biology Reviews, helps explain why the pathogen is so difficult to contain and warns that outdated diagnostics and limited treatments lag behind. It was conducted by Dr. Neeraj Chauhan of the Hackensack Meridian CDI in New Jersey, Dr. Anuradha Chowdhary of the University of Delhi’s Medical Mycology Unit and Dr. Michail Lionakis, chief of the clinical mycology program at the National Institutes of Health.
Their findings stress the need to develop “novel antifungal agents with broad-spectrum activity against human fungal pathogens, to improve diagnostic tests and to develop immune- and vaccine-based adjunct modalities for the treatment of high-risk patients,” the researchers said in a statement.
GROWING ANTIBIOTIC CRISIS COULD TURN BACTERIAL INFECTIONS DEADLY, EXPERTS WARN
“In addition, future efforts should focus on raising awareness about fungal disease through developing better surveillance mechanisms, especially in resource-poor countries,” they added. “All these developments should help improve the outcomes and prognosis of patients afflicted by opportunistic fungal infections.”
Candida auris can survive on skin and hospital surfaces, allowing it to spread easily. (iStock)
First identified in 2009 from a patient’s ear sample in Japan, C. auris has since spread to dozens of countries, including the U.S., where outbreaks have forced some hospital intensive care units to shut down, according to the researchers.
The fungus poses the greatest risk to people who are already critically ill, particularly those on ventilators or with weakened immune systems. Once infected, about half of patients may die, according to some estimates.
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Unlike many other fungi, C. auris can survive on human skin and cling to hospital surfaces and medical equipment, allowing it to spread easily in healthcare settings.
“It is resistant to multiple antifungal drugs, and it tends to spread in hospital settings, including on equipment being used on immunocompromised and semi-immunocompromised patients, such as ventilators and catheters,” Dr. Marc Siegel, Fox News senior medical analyst and clinical professor of medicine at NYU Langone, previously told Fox News Digital.
Scientists say the unique cell wall structure of C. auris makes it harder to kill. (iStock)
It is also frequently misdiagnosed, delaying treatment and infection control measures.
“Unfortunately, symptoms such as fever, chills and aches may be ubiquitous, and it can be mistaken for other infections,” Siegel said.
In September, he said intense research was ongoing to develop new treatments.
Only four major classes of antifungal drugs are currently available, and C. auris has already shown resistance to many of them. While three new antifungal drugs have been approved or are in late-stage trials, researchers warn that drug development has struggled to keep pace with the fungus’s evolution.
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Despite the sobering findings, there is still room for cautious optimism.
The fungus can cling to skin and hospital surfaces, aiding its spread. (iStock)
In separate research published in December, scientists at the University of Exeter in England discovered a potential weakness in C. auris while studying the fungus in a living-host model.
The team found that, during infection, the fungus activates specific genes to scavenge iron, a nutrient it needs to survive, according to their paper, published in the Nature portfolio journal Communications Biology in December.
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Because iron is essential for the pathogen, researchers believe drugs that block this process could eventually stop infections or even allow existing medications to be repurposed.
“We think our research may have revealed an Achilles’ heel in this lethal pathogen during active infection,” Dr. Hugh Gifford, a clinical lecturer at the University of Exeter and co-author of the study, said in a statement.
New research is underway to develop better treatments and diagnostics for C. auris. (iStock)
As researchers race to better understand the fungus, officials warn that strict infection control, rapid detection and continued investment in new treatments remain critical.
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Health experts emphasize that C. auris is not a threat to healthy people.
Fox News Digital has reached out to the CDI researchers and additional experts for comment.
Fox News Digital’s Angelica Stabile contributed reporting.
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