Senior black couple playing doubles tennis.

With You Throughout Life

As more people live longer, there's a growing population of older adults with type 1 and type 2 diabetes. These older patients can experience unique challenges when trying to manage their condition. For example, poor vision and dexterity can make it harder for some older adults to take medication. In addition, many of our patients have recently lost spouses, friends, and family members; making it difficult to feel well, eat healthy and exercise.

At Joslin Diabetes Center, we’ve designed a Geriatric Program to meet the needs of older adults. Our clinic evaluates the physical, social, and emotional health of our patients, and identifies any barriers to their care. The goal of our program is to offer:

  • The best diabetes control that takes into account our patients’ overall health, abilities, and wishes
  • Education to help patients be independent and perform self-care
  • Nutrition and exercise recommendations based on patients’ capabilities and goals
  • Clear communication with patients and family members
  • Recognition and support for the dignity and self-efficacy of every patient

Your Journey at Joslin

Our Geriatric Clinic supports these patients through best-in-class medical treatments, the latest research, and patient education and support.

Our doctors rely on several different approaches to diagnose diabetes and prediabetes:

  • A1C: This test measures your average blood glucose for the past couple of months. It doesn’t require you to fast or drink a special liquid. If you have an A1C of greater than or equal to 6.5%, you will be diagnosed with diabetes.
     
  • Fasting plasma glucose (FPG): This diagnostic test requires you to fast for at least eight hours before the test, so it’s usually done in the morning before you eat breakfast. An FPG will test your fasting blood glucose levels. If your levels are 126 mg/dl or higher, you will be diagnosed with diabetes. 
     
  • Oral glucose tolerance test (OGTT): The OGTT checks your blood glucose levels before and two hours after you drink a special liquid. With this test, your doctor can learn how your body processes glucose. If your two-hour blood glucose level is 200 mg/dl or higher, you will be diagnosed with diabetes.
     
  • Random (casual) plasma glucose test: This is a blood test that can be done at any time. Doctors will often order this test for patients with severe diabetes symptoms. If the test reports a blood glucose of greater than or equal to 200 mg/dl, you will be diagnosed with diabetes.

Before designing a treatment plan, our clinical team evaluates patients in several areas. This helps us better understand any barriers to care — and recommend a successful care approach. During one of your first visits, we will ask about your:

  • Medical history
  • Medication use
  • Ability to perform self-care behaviors
  • Hypoglycemia severity and frequency
  • Memory
  • Problem solving skills
  • Mood
  • Nutritional intake
  • Physical activity
  • Social background and support system

In general, we we’ve found these techniques help our patients thrive and enjoy better health:

  • Monitoring blood sugar: We ask our patients to monitor and record their blood sugar throughout the day. This makes sure their blood sugar levels stay in check. We also offer regular A1C testing at our clinic. 
     
  • Insulin therapy: Many people with type 1 diabetes, as well as some people with type 2 diabetes, need insulin therapy. We offer a range of the latest insulin therapies, and your doctor will work with you to find the right approach for you.
     
  • Medication: Sometimes we prescribe oral or injected medications to support the pancreas and release insulin, or prevent the release of glucose from the liver. Your doctor will talk with you about available medication options and if they’re right for you.
     
  • Nutrition counseling: Our team includes a registered dietitian who can prepare a specialized nutrition plan for you. You can work together to understand the types of foods you should eat, how much, and how often. 
     
  • Exercise plans: Regular exercise can help regulate your blood sugar levels. Plus, exercise can give you more energy and supports your mental wellbeing. An exercise physiologist will prescribe a doable exercise plan that includes activities you enjoy.
     
  • Specialty care, when needed: We are in close proximity to some of Boston’s top hospital and specialists. When needed, we partner with experts at Beth Israel Deaconess Medical Center for bariatric surgery, transplantation, and other specialized care.

Educating patients is a big part of what we do at Joslin. Our experienced nurse educators offer one-on-one consultations with patients, as well as group classes. In our classes, we cover important topics, such as:

  • The basics of diabetes
  • Your first steps in living with diabetes
  • Creating an exercise plan
  • Healthy foods to eat
  • How to use an insulin pump
  • New technologies that treat diabetes
  • And much more

Our patients become lifelong members of the Joslin family. We work with them throughout their lives to help keep diabetes under control.

This starts with careful blood glucose monitoring — both throughout the day and through regular A1C testing.

Because lifestyle changes make a big impact on diabetes, our dietitians and exercise physiologists will help you maintain your health going forward. We’ll recommend adjustments to your exercise routine and diet, as needed, and do everything possible to keep complications at bay.

As a Joslin patient, you’ll be welcomed by our whole team, get to know our staff, and be invited to patient events and activities. Joslin patients receive more than just treatment for diabetes — they experience lifelong support and community.

Meet Our Specialists

Medha Munshi
Medha Munshi, MD
Staff Physician
Director, Geriatric Diabetes Program
Associate Professor of Medicine, Harvard Medical School

To make an adult care appointment, call 617-309-2400 or make an appointment online.