Mae Sheikh-Ali, MD, Assistant Professor of Medicine, University of Florida College of Medicine, Division of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
Joe M. Chehade, MD, Associate Professor of Medicine, University of Florida College of Medicine, Division of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.

Over the past decade, eight classes of drugs have been used to treat diabetes; however, insulin remains the most effective and least costly treatment for older adults. The American Diabetes Association has recommended that the approach to drug therapy of diabetes consider insulin a first-tier therapy. Nevertheless, there is a general reluctance among physicians and patients alike to accept insulin. The initiation of insulin therapy is especially challenging in older adults, who often have multiple comorbidities and physical limitations. In this article, we present a case-based approach to the initiation of insulin therapy in older adults.
Key words: diabetes, older adults, insulin therapy, glycemic goals, antihyperglycemic agents.