Tags

Type your tag names separated by a space and hit enter

Transitioning and adjusting insulin analog therapy in elderly patients.
Consult Pharm. 2008 Apr; 23 Suppl B:17-23.CP

Abstract

OBJECTIVES

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.

DATA SOURCES

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.

Authors+Show Affiliations

University of North Carolina at Chapel Hill-School of Pharmacy, Chapel Hill, North Carolina, USA. bbray@triad.rr.com

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18540789

Citation

Bray, Bryan. "Transitioning and Adjusting Insulin Analog Therapy in Elderly Patients." The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists, vol. 23 Suppl B, 2008, pp. 17-23.
Bray B. Transitioning and adjusting insulin analog therapy in elderly patients. Consult Pharm. 2008;23 Suppl B:17-23.
Bray, B. (2008). Transitioning and adjusting insulin analog therapy in elderly patients. The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists, 23 Suppl B, 17-23.
Bray B. Transitioning and Adjusting Insulin Analog Therapy in Elderly Patients. Consult Pharm. 2008;23 Suppl B:17-23. PubMed PMID: 18540789.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transitioning and adjusting insulin analog therapy in elderly patients. A1 - Bray,Bryan, PY - 2008/7/17/pubmed PY - 2008/8/1/medline PY - 2008/7/17/entrez SP - 17 EP - 23 JF - The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists JO - Consult Pharm VL - 23 Suppl B N2 - OBJECTIVES: 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. DATA SOURCES: 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. SN - 0888-5109 UR - https://www.unboundmedicine.com/medline/citation/18540789/Transitioning_and_adjusting_insulin_analog_therapy_in_elderly_patients_ L2 - https://medlineplus.gov/diabetesmedicines.html DB - PRIME DP - Unbound Medicine ER -