Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Review
Volume 1, Number 1, April 2011, pages 9-13
Diabetes in Elderly
Tables
American Geriatrics Association | Department of Veteran Affairs |
---|---|
< 7% in adults with good functional status | < 7% if life expectancy is > 15 years |
< 8% if frail or life expectancy is < 5 years | < 8% if life expectancy is 5 - 15 years |
< 9% if life expectancy is < 5 years |
Insulin | Onset | Peak | Duration |
---|---|---|---|
Rapid | |||
Lispro, Aspart, Glulisine | 5 - 15 minutes | 30 minutes to 2 hours | 3 - 4 hours |
Short | |||
Regular | 30 - 60 minutes | 2 - 3 hours | 6 - 8 hours |
Intermediate | |||
NPH | 2 - 4 hours | 6 - 7 hours | 10 - 20 hours |
Long acting | |||
Detemir | 1 hour | Peakless | 17 hours |
Glargine | 1 - 3 hours | Peakless | 24 hours |
Choice of regimen | |
---|---|
Single dose long acting insulin | Less than adequate control of sugars and a higher risk of hypoglycemia if used with OADs. |
Twice daily dose of long acting insulin | Better but often inadequate glycemic control. |
Premixed short/rapid acting and long acting insulins (NPH and regular 70/30) | Only two insulin injections needed. |
Basal bolus long acting with short/rapid acting (premeal) | Multiple insulin injections needed but with best control. Increased risk of hypoglycemia. |
Clinical scenario | When to perform SMBG | Explanation |
---|---|---|
Initiation of insulin | Premeal | To fix the dose of basal insulin |
After achieving pre-meal target | Postprandial | To fix the dose of rapid/short acting pre-meal insulin |
Stable insulin regimen achieved | Three point testing with judicious mix of pre- and postprandial | To recognize a failing regimen, an asymptomatic hypoglycemia |
Unexplained hyperglycemia in morning | 3 a.m. in the morning | To recognize somogyi phenomenon |