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Insulin:
Insulin is indicated when treatment goals are not being met with diet, exercise, and oral medications. No specific regimen or form of insulin has been identified as particularly advantageous to the elderly. It is difficult to achieve euglycemia with a single daily dose of intermediate acting insulin. Although always a stressful therapy to initiate, insulin injections for the elderly can be particularly complex, predisposing to medication error. Problems include visual impairment and difficulty in drawing and injecting the exact dose of insulin, impaired manual dexterity, decreased sensation in the hands, limited access to injection sites, and difficulties in monitoring blood glucose. However, none of these considerations are absolute contraindications to insulin therapy, solutions can usually be found for each.
Insulin Analogues:
Insulin lispro is an analogue that has a more rapid onset and shorter duration of action compared with regular insulin. Therefore, it is associated with greater relative reductions in postprandial blood glucose concentrations and may provide greater patient convenience in terms of the timing of insulin injections in relation to meals with the added benefit of less incidences of hypoglycemia. This is a specific advantage in the elderly as patients can be advised to take insulin immediately before meals precluding the need to wait for half-hour after taking injection.
In conjunction with long-acting insulin, such as insulin glargine or ultralente insulin, the rapid-acting analogues provide tight control of blood glucose levels throughout the day. Insulin glargine has a nearly peakless profile and lasts for more than 24 hours. 38 For geriatric use the initial dosage, dose increments, and maintenance dosage should be conservative to avoid hypoglycemia.
CONCLUSION:
As age advances, the quality of life becomes more important than the length of life. A well-controlled elderly diabetic who has no major complications, and is adept at self-care, should be the goal of all physicians treating diabetic patients.
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