Commencing Insulin Therapy in the Older Patient with Type 2 Diabetes

Stuart Ross, MB, ChB, FRACP, FRCP(C), Clinical Professor of Medicine, University of Calgary, Calgary, AB.

With glucose targets becoming more stringent, there is a growing need for insulin therapy. The prevalence of diabetes is rising and many of these new diabetic patients will be older and will require insulin as part of their management. When commencing the older patient on insulin, the advantages and concerns of treatment need to be reviewed. Aspects such as physical, mental and visual problems must be carefully assessed; practical and safe glucose targets must be established based on the individual patient's needs and capabilities. Insulin can initially be commenced at nighttime and slowly increased to reach safe morning glucose targets and, if required, fast-acting analog insulins can be added during the day. Complex insulin regimens should be avoided unless essential.
Key words: insulin, analog insulin, glucose targets, hypoglycemia.