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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No sex for the win? This was the advice given to this year’s NBA champions.
New York Knicks owner James Dolan addressed the now-champs as they headed into the playoffs in April 2026, acknowledging their high potential to eventually win the championship.
“I don’t know if you understand what it would mean for you to win a championship this year … It would be life-changing,” he said. “It will stick with you the rest of your lives, and if you don’t win, you’ll be thinking about it the rest of your lives.”
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As Dolan’s inspirational speech to the team went on, he explained how the next 10 weeks would require each player to make sacrifices – watching their diets, getting proper sleep and perhaps even abstaining from sex.
“You need sacrifice and you need to eliminate all the distractions around you,” he said.
Jalen Brunson of the New York Knicks celebrates with the Bill Russell NBA Finals Most Valuable Player Award trophy and Knicks owner James Dolan after defeating the San Antonio Spurs in Game Five of the 2026 NBA Finals at Frost Bank Center in San Antonio, Texas, on June 13, 2026. (Gregory Shamus/Getty Images)
“I had this idea that maybe you should give up sex for the next 10 weeks,” the owner said. “You don’t have to give up sex for the next 10 weeks – but, like the Spartans … They denied themselves, so that they can have an edge. Get the edge.”
This received a few snickers from the team, and Dolan responded, “Don’t tell [your wives and girlfriends] you’re not going to have sex and don’t tell them it was my idea. But let them know what this is going to be like … and how they’re going to have to sacrifice, too.”
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Dr. Anna Elton, licensed marriage and family therapist and clinical sexologist in Massachusetts, confirmed that this belief has been around for centuries, dating back to the ancients Spartans and early Olympic competitors.
Avoiding sex can preserve energy, increase aggression and sharpen focus, according to Elton.
The theory behind abstaining from sex for better athletic performance supports that it can preserve energy, increase aggression and sharpen focus. (iStock)
But modern research has found little evidence that consensual sexual activity negatively impacts strength, endurance, reaction time or athletic performance when it occurs at least 10 hours before competition, the doctor countered.
However, “activity very close to competition may affect recovery measures,” she added. What may be more important, according to Elton, is the psychological value of abstinence.
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“Choosing to abstain can reinforce discipline and total commitment to a larger goal,” she said. “In those cases, the advantage may come more from mindset and focus than from any physical effect.”
“Whether the sacrifice is alcohol, social activities, favorite foods or sex, the message is often the same: ‘We are all in.’”
New York Knicks guard Jalen Brunson celebrates with teammates after the Knicks defeated the San Antonio Spurs in game five of the 2026 NBA Finals at Frost Bank Center in San Antonio, Texas, on June 13, 2026. (Geoff Burke/Imagn Images)
The science of abstinence
This discussion has historically focused on men, which Elton said is often based on “misconceptions about testosterone and energy depletion.”
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“Research has not demonstrated that normal sexual activity causes a meaningful decline in athletic performance, and concerns about testosterone depletion have not been consistently supported by the evidence,” she said.
“For women, sexual activity may have additional benefits related to stress reduction, emotional regulation and relationship satisfaction.”
Abstaining from sex for athletic performance may create a sense of discipline, minimize distractions, maintain focus on training and reinforce a team culture centered on sacrifice and commitment, experts say. (iStock)
In a separate interview with Fox News Digital, Dr. Anthony Puopolo, a men’s health expert and lead medical provider for RexMD, echoed Elton’s assessment that research largely does not support abstinence as a performance enhancer.
This is despite a small amount of evidence that suggests engaging in sexual activity within two hours of competition could pose a risk to cardiovascular recovery.
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“Unfortunately, nearly all studies (99%) have been conducted in males aged 20 to 40, so there is virtually no data on female athletes, older athletes or diverse populations,” said the Puerto Rico-based expert. “We know what to tell the Knicks, but we are not sure what to recommend for the New York Liberty.”
Importance of connection
Elton said abstinence may still offer psychological benefits for some competitors. “For some athletes, it can become part of a pre-competition ritual that enhances confidence,” she told Fox News Digital.
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Some other potential benefits of sexual activity include stress reduction, improved sleep, mood enhancement, emotional connection with a partner and relief from performance-related tension.
“Strong, supportive relationships are associated with better psychological resilience, which can be valuable during high-pressure competitions,” Elton said.
“One of the most overlooked performance advantages may be having a supportive relationship waiting at home,” a doctor said. (iStock)
“Ultimately, there is no universal rule,” she went on. “What helps one athlete perform at their best may not help another.”
Elton stressed that sleep, recovery, nutrition, stress management and support from loved ones are universal performance boosters.
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“Athletes devote tremendous attention to training their bodies, while overlooking the importance of their personal relationships,” she cautioned. “A supportive partner can be one of the greatest assets during a demanding season.”
“If competition requires temporary sacrifices, make those decisions together and keep communication open.”
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Eliminating sugar from your diet may seem like the key to healthy eating, but research suggests it could have unintended effects on digestive health.
A study presented at ENDO 2026, the Endocrine Society’s annual meeting, suggests that a total lack of sucrose, or table sugar, may harm gut health and disrupt the body’s natural metabolism.
To explore how the total absence of dietary sugar impacts the body, researchers at the Dasman Diabetes Institute in Kuwait City conducted a 16-week study on two groups of mice. Both groups were placed on a low-fat diet, but with one critical difference.
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One group consumed a low-fat diet that included a standard amount of sucrose, while the other group ate a low-fat diet that was completely sugar-free, according to the study’s press release.
Throughout the trial, the scientists monitored a wide variety of physiological factors, including the animals’ weight, glucose tolerance, insulin sensitivity, hormone levels, internal inflammation and the specific composition of their gut bacteria.
A total lack of dietary sugar can cause imbalances in the gut bacteria and lead to signs of fatty liver disease, even without any weight gain, researchers said. (iStock)
The study outcome suggested that completely removing sugar caused several unexpected health problems.
“Completely removing sucrose from a low-fat diet may unexpectedly disrupt gut health and promote inflammation and metabolic dysfunction,” Rasheed Ahmad, principal scientist and head of the Immunology & Microbiology Department at the Dasman Diabetes Institute, said in the release.
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Even though the mice on the sugar-free diet did not gain any extra weight compared to the control group, their internal health indicators deteriorated.
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The animals that lacked sucrose developed an imbalance in their gut microbes and increased inflammation within the intestines and liver.
They also showed signs of poor glucose regulation, insulin resistance and cellular changes associated with fatty liver disease, according to the research.
Future dietary guidelines may shift away from strict, absolute sugar bans and instead focus on overall gut health through balanced nutrition. (iStock)
“The findings suggest that complete removal of sucrose from a low-fat diet may negatively affect gut microbiota and metabolic health,” Ahmad concluded.
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While the risks of high-sugar diets are well-established, the researchers noted that little attention has been given to the effects of completely eliminating sugar from low-fat meals.
Scientists say these new findings highlight that dietary carbohydrates play a valuable role in supporting balance between the immune system and the gut microbiome.
Completely cutting sucrose from a low-fat diet can unexpectedly trigger gut inflammation and disrupt the metabolism, experts say. (iStock)
Because this research was conducted on mice over a relatively short 16-week period, further clinical trials are necessary to determine whether a completely sugar-free diet causes the same gut and liver inflammation in humans.
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Additionally, the study focused specifically on removing sucrose from low-fat meals, meaning the results might not apply to people eliminating sugar while following higher-fat or ketogenic eating plans, the researchers noted.
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The team believes that future dietary guidelines may shift away from strict, absolute sugar restrictions and instead place a greater emphasis on maintaining a diverse, healthy population of gut bacteria through balanced nutrition.
“In the long term, these findings could help improve strategies for preventing and managing metabolic disorders, fatty liver disease and chronic inflammatory conditions,” Ahmad said.
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