Transitioning and adjusting insulin analog therapy in elderly patients.
OBJECTIVE
To identify and address issues specific to elderly patients with diabetes, including goal setting, prevention of hypoglycemia,and product and device selection, and to summarize recommendations for the addition and dosing of insulin to treatment regimens and the appropriate continuance or discontinuance of oral medications in elderly patients taking insulin.


METHODS
Live symposium presentation based on clinical practice and research, and literature and published studies on the treatment and management of diabetes.


CONCLUSIONS
Most patients with long-standing diabetes eventually will require insulin therapy of some sort. Insulin therapy typically is started as basal (long-acting insulin) as an adjunct to oral therapy. Prandial (rapid-acting insulin before meals) may be added an injection at a time. In its most sophisticated regimen, insulin is used as multiple, daily injections (a single injection of long-acting insulin and three injections of rapid-acting insulin before meals), with the subsequent discontinuation of oral therapy. Insulin analogs, though slightly more expensive than human and isophane insulin, provide much more physiologic insulin action, resulting in better glucose control and lower rates of hypoglycemia. Hypoglycemia is the major concern of using insulin in elderly patients; thus, a regimen that minimizes this risk shifts the risk/benefit ratio in favor of insulin analogs. The use of sliding scale insulin should be discouraged.
University of North Carolina at Chapel Hill-School of Pharmacy, Chapel Hill, North Carolina, USA. bbray@triad.rr.com
Bryan
B
Bray
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D010353:Patient Education as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin