Special considerations for the use of insulin in older adults

The goal of this article is to provide guidance in prescribing insulin for older adults.

The prevalence of diabetes increases with age, with almost 30% of the elderly population diagnosed with this metabolic disorder. Along with the well-documented microvascular and microvascular complications of diabetes, older adults are at increased risk of numerous other complications, such as dementia, risk of falling, frailty, and incontinence.

Whether designing a new insulin regimen or adjusting an existing regimen, many factors must be considered; these include advantages and disadvantages of each insulin option; adverse events, particularly hypoglycemia and increased risk of falls; and comorbid conditions. When assessing insulin options for older adults, a thorough evaluation of key features, such as the pharmacokinetics and timing of administration in relation to meals, along with cost, will assist clinicians in selecting an appropriate regimen. Hypoglycemia and risk of falls are increased in older adults; tight glycemic goals must be weighed against the risk of these adverse events. The presence of comorbid conditions may interfere with older adults' ability to inject insulin and monitor their blood sugar appropriately. Specialized devices, such as insulin pens, may offer a means to assist older adults with their insulin therapy.

Prescribing insulin to older patients must be individualized and tailored to meet the needs of each individual.