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?”
Health
Single infusion of controversial drug changed severe depression symptoms within hours, study finds
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People experiencing severe depression with suicidal symptoms may not have to wait weeks for traditional antidepressants to take effect.
A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients.
Originally developed as an anesthetic, ketamine is a medicine that can reduce pain and, in some cases, help treat depression, but it can also be misused as a recreational drug, experts warn.
SINGLE DOSE OF POWERFUL PSYCHEDELIC CUTS DEPRESSION SYMPTOMS IN CLINICAL STUDY
Researchers from the University of Connecticut School of Medicine reviewed 26 clinical trials that included more than 1,100 patients. Approximately 626 received ketamine and 540 served as controls who did not take the drug.
Most of the trials included patients with major depressive disorder, but 11.5% included those with bipolar depression and 7.7% included people with both unipolar and bipolar depressive diagnoses.
A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients with treatment-resistant depression. (iStock)
Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found.
Patients reported fewer depressive symptoms after a week and reduced suicidal thoughts for up to a month after one ketamine infusion. Those who received repeated ketamine infusions showed a similar reduction of suicidal and depressive symptoms at the end of the treatment.
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The most common adverse effects of ketamine – including headaches, numbness, dissociation (“out of body” experiences), nausea, dizziness and visual disturbances – were temporary and resolved within hours of the infusion.
Rarer, more serious side events included hospitalization, suicide attempts and suicide, but most were unrelated to ketamine, the review stated.
The analysis was published in May in JAMA Psychiatry.
Treatment-resistant depression
Major depressive disorder is a formal psychiatric diagnosis affecting approximately 280 million people globally, according to recent research.
Effective treatment involves a combination of therapy and medication, frequently antidepressants. However, for a few patients, symptoms do not respond to multiple therapies, a condition known as treatment-resistant depression, doctors say.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions.”
These patients are at a higher risk of very serious, sometimes tragic consequences, including suicidal thoughts, suicide attempts and death.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions,” lead author Taeho Greg Rhee, PhD, of the University of Connecticut School of Medicine, told Fox News Digital. “This is still a safer option when compared to electroconvulsive therapy (ECT).”
Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found. (iStock)
Traditional antidepressants stabilize mood by slowly elevating serotonin levels in the brain, but it can take weeks for the full effect to be achieved.
Ketamine, in contrast, works rapidly by blocking glutamate, a neurotransmitter that can impact emotions negatively when levels are too high in the brain, according to Cleveland Clinic.
Implications for care
The authors say their findings have two important potential clinical applications.
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First, ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation.
Experts caution that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment. (iStock)
Second, the effects of a single ketamine infusion are relatively short-lived – as almost all patients relapsed with depressive symptoms after a single infusion – so those with treatment-resistant depression will need repeated sessions.
“While intravenous ketamine is not yet FDA-approved for treating depression, it may still be used with off-label indications for those with severe depression and/or with a high risk of suicidal behaviors,” said Rhee.
Experts urge caution despite promise
Dr. Lama Bazzi, a psychiatrist in private practice in New York City, has had several patients receive ketamine infusions.
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“For a small subset of patients in a major depressive episode or struggling with suicidal thoughts, intravenous ketamine can be genuinely lifesaving,” Bazzi, who was not involved in the study, told Fox News Digital. “The relief they experience is almost immediate, offering them distance from the intensity of their emotions.”
However, she cautions that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment.
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Ketamine is not a panacea, Rhee agreed, warning of the potential risk of abuse and addiction.
“It should only be used medically,” he advised.
Ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation, some experts claim. (Getty Images)
Dr. Marc Siegel, Fox News senior medical analyst, noted in previous comments to Fox News Digital that ketamine is increasingly being used to treat severe depression, but emphasized that it should be administered under careful medical supervision because of its potential risks.
Study limitations
Although the studies compared ketamine with a placebo, some patients may have realized they were receiving the drug. This could have influenced how they reported their symptoms and how effective they perceived the treatment to be, according to the researchers.
“It should only be used medically.”
Another limitation is the small sample size of the studies, which could make the effects seem disproportionately magnified.
Also, as this was a review of many different studies, it is challenging to apply the findings to the general population, the researchers noted.
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“While long-term outcomes have not been studied, I believe that when patients are severely depressed or suicidal, ketamine is sometimes the only choice that almost always works,” Bazzi added.
Anyone interested in exploring alternative depression treatments should first consult a doctor.
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Tick bite-related ER visits are at their highest seasonal levels since 2017 across most U.S. regions, raising concerns about increased Lyme disease and other tick-borne illnesses.
That’s according to recent data from the Centers for Disease Control and Prevention’s Tick Bite Tracker, which monitors weekly emergency department visits associated with tick bites across the country.
For every 100,000 ER visits, approximately 71 were related to tick bites in April 2026, compared to a historical seasonal average of roughly 30 per 100,000.
DOCTORS REVEAL KEY SIGNS OF LYME DISEASE AS TICK SEASON INTENSIFIES ACROSS US
Some of the highest rates of tick-based ER visits were among children younger than 10 years and adults between 70 and 79 years.
A close-up shows a parasitic mite in motion on a human fingertip, highlighting the potential for disease transmission such as encephalitis. (iStock)
“Over the past three decades, the geographic range of the blacklegged tick has expanded significantly, and with it, the risk of Lyme disease and other Ixodes-transmitted infections,” Dr. Steven Goldberg, a family medicine physician who practices urgent care and family medicine at UofLHealth in Louisville, Kentucky, told Fox News Digital.
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“The Ohio River Valley region is one of the most striking examples — Lyme disease cases in Ohio have increased roughly 10-fold over the past decade, likely driven by the convergence of Northeastern and Upper Midwestern tick populations meeting in that corridor.”
States like Virginia and West Virginia, as well as areas south of the traditional endemic zone, are reporting increasing tick abundance and disease cases, the doctor noted.
“Over the past three decades, the geographic range of the blacklegged tick has expanded significantly.”
“The lone star tick is also expanding its range northward beyond its traditional stronghold in the Southeast, which means diseases like ehrlichiosis and alpha-gal syndrome are appearing in regions where clinicians may not yet be thinking about them,” he warned.
Some climate studies predict that the blacklegged tick’s suitable habitat could expand by over 200% by the end of the century, Goldberg noted, including into Canada and across the central and southern U.S.
What’s driving the spike?
“Warmer, wetter conditions allow ticks to survive in habitats that previously would have been too cold,” said Dr. Suraj Saggar, chief of infectious disease at Holy Name Medical Center in Teaneck, New Jersey. “Milder winters also extend the lifespan of both ticks and the animals they feed on, accelerating tick reproduction and shortening their life cycles.”
Areas that historically experienced longer, colder winters or significant snow cover are now more hospitable to ticks, the doctor noted.
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“As temperatures rise and precipitation patterns change, ticks are able to spread northward and thrive in new ecosystems,” he said.
Another contributing factor is increased land development and human expansion into wooded and grassy areas, as well as reforestation of formerly agricultural land.
“As temperatures rise and precipitation patterns change, ticks are able to spread northward and thrive in new ecosystems,” an expert said. (iStock)
“The recovery and expansion of white-tailed deer populations — critical hosts for adult blacklegged ticks — has been a major driver,” Goldberg added. “Deer density is positively associated with Lyme disease incidence. Small mammal communities, particularly white-footed mice that serve as key reservoir hosts for Borrelia burgdorferi, also play a central role.”
Tick-borne diseases
Tick bites are known to transmit numerous illnesses, the most widespread of which is Lyme disease, a bacterial infection.
“Lyme disease cases alone have increased roughly two- to threefold over the past 20 years,” Saggar said. Approximately 476,000 Americans are diagnosed and treated for Lyme disease each year, per CDC surveillance data.
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Also common are anaplasmosis and ehrlichiosis, two different types of bacterial infections, according to the doctor. Tick bites can also cause babesiosis, a malaria-like parasitic disease that infects and destroys red blood cells.
“Another growing concern is alpha-gal syndrome, a condition in which a (lone star) tick bite triggers a serious allergic reaction to red meat,” Saggar said. “In rare cases, people have died from anaphylactic reactions linked to alpha-gal syndrome following a tick bite.”
Some common symptoms of tick-borne illness include fever, chills, fatigue, headaches, muscle aches and joint pain. (iStock)
Ticks can also transmit viruses, including the Powassan virus, which can cause severe neurologic injury.
“Powassan virus disease is arguably the most concerning emerging tick-borne infection,” said Goldberg, who is also chief medical officer at HealthTrack. “It’s transmitted by the same blacklegged tick that carries Lyme disease, but unlike Lyme, it can be transmitted within minutes of tick attachment.”
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Powassan can cause severe encephalitis with a roughly 10% to 15% fatality rate, and more than half of survivors have lasting neurological deficits, Goldberg noted.
In the Rocky Mountain states, the Rocky Mountain wood tick (Dermacentor andersoni) transmits Rocky Mountain spotted fever and Colorado tick fever.
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“In the Southeast and South-Central U.S., the lone star tick (Amblyomma americanum) drives a different set of concerns: ehrlichiosis, tularemia, and two emerging viral threats — Heartland virus and Bourbon virus,” said Goldberg.
Symptoms to watch for
Some common symptoms of tick-borne illness include fever, chills, fatigue, headaches, muscle aches and joint pain, according to Saggar.
Another sign is the classic “bull’s-eye” rash associated with Lyme disease, known medically as “erythema migrans.”
“If you think you have been bitten by a tick, you should seek medical attention if you develop symptoms after a known tick bite or after spending time in tick-prone areas, especially during the spring, summer and fall.” (iStock)
“Because testing can sometimes be falsely negative early in the disease process, doctors may treat patients based on symptoms and exposure history rather than waiting for laboratory confirmation,” Saggar noted.
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“If you think you have been bitten by a tick, you should seek medical attention if you develop symptoms after a known tick bite or after spending time in tick-prone areas, especially during the spring, summer and fall.”
Preventing tick bites
As there are no vaccines currently available for any tick-borne disease in the U.S., prevention is the most effective strategy.
Goldberg shared the following recommended prevention strategies.
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- Use EPA-approved repellents, including DEET, picaridin, IR3535 or oil of lemon eucalyptus on exposed skin. Treat clothing and gear with permethrin (a synthetic insecticide and repellent) or purchase pre-treated clothing.
- Wear light-colored clothing (to spot ticks more easily), long sleeves and long pants tucked into socks when in wooded or grassy areas.
- After spending time outdoors, check your entire body, paying special attention to the scalp, behind the ears, armpits, groin and behind the knees, the doctor advised. It’s also recommended to shower within two hours of coming indoors.
- Tumble-dry clothing on high heat for at least 10 minutes to kill any ticks on clothing.
- Remove ticks promptly and properly. Using fine-tipped tweezers, grasp the tick as close to the skin as possible, and pull upward with steady, even pressure. Clean the bite area afterward.
Approximately 476,000 Americans are diagnosed and treated for Lyme disease each year, per CDC data.
“The longer a tick is attached, the higher the risk of disease transmission — for Lyme disease, transmission generally requires at least 36 hours of attachment,” Goldberg said. “The Powassan virus can be transmitted much more quickly.”
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