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Minerva Endocrinologica 2015 December;40(4):283-95

language: English

Insulin therapy in the elderly with type 2 diabetes

Eriksson J. G. 1, 2, 3, Laine M. K. 1, 4

1 University of Helsinki, Department of General Practice and Primary Health Care and Helsinki University Hospital, Helsinki, Finland;
2 National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland;
3 Folkhälsan Research Centre, Helsinki, Finland;
4 Vantaa Health Center, Vantaa, Finland


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Type 2 diabetes (T2D) is a progressive disorder and therefore many elderly people with T2D will require insulin therapy in order to reach treatment targets and to optimize quality of life. It is commonly assumed that insulin is underutilized in elderly T2 diabetics because of fear that it is too complicated to use. With the use of long-acting insulin analogues it has become much easier to use insulin in elderly patients as once daily pen injections. When basal insulin treatment is initiated in T2D it is often added to the oral medication. The use of basal insulin analogues (e.g. detemir and glargine) with relatively little peaking effects has made insulin therapy in elderly subjects a relatively straightforward process. Newer insulin analogues are also discussed. The use of prandial insulin in addition to basal insulin and use of premixed insulin analogues is also discussed and illustrated with patient cases. Avoidance of hypoglycemia is an important factor to consider when choosing therapeutic agents for elderly T2D diabetics. This is certainly also true when establishing glycemic goals. Therefore insulin must be used with caution and wisely and the motto “start low and go slow” is a good principle. Basal insulin therapy in combination with oral drugs, most often metformin ‑ is the most convenient initial regimen. However, all next steps, from one to two or even more daily injections in elderly T2D subjects should be considered carefully.

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johan.eriksson@helsinki.fi