[Prevention of insulin-induced hypoglycaemia in the elderly]

The number of patients with diabetes who are receiving insulin therapy is increasing, and as a consequence the burden of insulin-related hypoglycaemia is increasing proportionally. In a recent paper, it was calculated that almost 100,000 patients visit the emergency department (ED) of American hospitals each year for insulin-related hypoglycaemia. Patients aged ≥ 80 years were twice as likely to visit the ED as younger patients. There are a number of possible reasons for this high risk, including: greater risk of direct or indirect injury arising from hypoglycaemia; higher prevalence of cognitive dysfunction; and age-induced loss of appetite, also referred to as anorexia of aging. The author proposes a de-escalating treatment strategy away from basal-bolus insulin regimens in frail elderly patients, combined with specific patient education focused on prevention of hypoglycaemia. Finally, all healthcare providers should be made aware of frequently occurring precipitating factors for hypoglycaemia, so that they can take timely precautionary action.