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
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Volume 1, Number 1, April 2011, pages 9-13

Diabetes in Elderly


Table 1. Goal of Therapy
American Geriatrics AssociationDepartment 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


Table 2. Classification of Insulins Based on Their Duration of Action
  Lispro, Aspart, Glulisine5 - 15 minutes30 minutes to 2 hours3 - 4 hours
  Regular30 - 60 minutes2 - 3 hours6 - 8 hours
  NPH2 - 4 hours6 - 7 hours10 - 20 hours
Long acting
  Detemir1 hourPeakless17 hours
  Glargine1 - 3 hoursPeakless24 hours


Table 3. Different Insulin Regimens
Choice of regimen
Single dose long acting insulinLess than adequate control of sugars and a higher risk of hypoglycemia if used with OADs.
Twice daily dose of long acting insulinBetter 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.


Table 4. Self-Monitoring of Blood Glucose (SMBG)
Clinical scenarioWhen to perform SMBGExplanation
Initiation of insulinPremealTo fix the dose of basal insulin
After achieving pre-meal targetPostprandialTo fix the dose of rapid/short acting pre-meal insulin
Stable insulin regimen achievedThree point testing with judicious mix of pre- and postprandialTo recognize a failing regimen, an asymptomatic hypoglycemia
Unexplained hyperglycemia in morning3 a.m. in the morningTo recognize somogyi phenomenon