Gerontological Considerations for Diabetes Mellitus According to the Department of Health and Human Services (2011), 18.5% of the United States population is over the age of 60. Of these, 10.9 million (26.9%) are diagnosed with diabetes mellitus (ADA, 2011). In Lewis and associates' textbook on medical-surgical nursing, Lewis states that the incidence of diabetes mellitus (DM) increases with age (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011.) The purpose of This article is to explore the disease process of diabetes mellitus in the geriatric population. Pathology According to Lewis and colleagues, DM is a chronic disease that affects multiple body systems. For the purposes of this article, only type 2 DM will be discussed, assuming that the majority of patients aged 60 years and older have this type. The primary defects of this disease consist of insulin resistance, decreased insulin production, inappropriate glucose production by the liver, and alterations in adipokine production. Insulin resistance is the result of defects in the body's insulin receptors. This finding predates all cases of type 2 DM and the development of impaired glucose tolerance. In insulin resistance, the beta cells of the pancreas are stimulated to increase insulin production to compensate for the lack of response from insulin receptors. Gradually, beta cells begin to fail to secrete enough insulin to meet the body's demands, resulting in hyperglycemia. As a result of increased glucose in the liver, the liver begins to malfunction and release glucose at inappropriate times, thus worsening hyperglycemia. Adding to the problem, glucose and fat metabolism is altered in adipose tissue, which is generally abundant in individuals with type 2 DM. (Lewis et al., 2011) In addition to these defects in DM, the normal aging process is associated with additional risks for the