The prevalence of type 2 diabetes increases with age, with 20% of individuals over
the age of 60 affected.55 The prevalence in long-term care (LTC) facilities may
be underestimated, making proper diagnosis and treatment a matter of great concern.
Caution should be exercised when administering insulin to elderly patients. In elderly
patients with diabetes, dosing should be conservative to avoid hypoglycemia. Hypoglycemia
is the most common adverse effect of insulin, including LANTUS®. Hypoglycemia
may be difficult to recognize in the elderly.
The signs and symptoms of hyperglycemia may also be atypical in the elderly. Additional
scrutiny may be required during the initial assessment to determine if a patient
has diabetes. Ask the patient or family members if the patient has shown specific
signs or symptoms of diabetes. Examine the patient’s medical records and test results
for evidence of diabetes risk factors. And evaluate the patient critically for signs
or symptoms consistent with diabetes or diabetic complications.58
The AMDA Long-Term Care Guidelines
The American Medical Directors Association (AMDA) has put forth a multistep process
for the treatment of LTC patients with diabetes.
1. Recognition
The AMDA outlines several conditions that may indicate a patient has diabetes. These
include:
- Blurred vision58
- New or increasing confusion58
- Lethargy58
- Polydipsia58
- Polyphagia58
- Weight loss58
- Worsening incontinence58
- Fruity breath odor58
2. Assessment
Once symptoms of diabetes have been recognized, the patient must be closely assessed:
- Confirm whether the patient has diabetes by ordering appropriate laboratory tests
- Assess the patient's hyperglycemia and identify the cause
- Evaluate the nature and severity of diabetes-related complications
3. Treatment58
If the cause and the severity of the diabetes has been outlined, the AMDA recommends:
- Adopting an interdisciplinary team model for treatment
- Ensuring that team members follow up on responsibilities
- Individualizing blood glucose goals and therapy
- Using insulin therapy early in cases of hyperglycemia
4. Monitoring58
Once a patient has been treated for diabetes, the AMDA recommends a 30-day monitoring
period, after which the patient’s condition may be reassessed.
Read the full AMDA Guidelines here
More about basal-prandial
insulin therapy >
CONTRAINDICATIONS
Lantus® is contraindicated in patients hypersensitive to insulin glargine or
one of its excipients.
WARNINGS AND PRECAUTIONS
Monitor blood glucose in all patients treated with insulin. Insulin regimens should
be modified cautiously and only under medical supervision. Changes in insulin strength,
manufacturer, type, or method of administration may result in the need for a change
in insulin dose or an adjustment in concomitant oral antidiabetic treatment.
Do not dilute or mix Lantus® with any other insulin or solution. If mixed or
diluted, the solution may become cloudy, and the onset of action/time to peak effect
may be altered in an unpredictable manner. Do not administer Lantus® via an
insulin pump or intravenously because severe hypoglycemia can occur. Insulin devices
and needles must not be shared between patients.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®,
and may be life-threatening.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
A reduction in the Lantus® dose may be required in patients with renal or hepatic
impairment.
DRUG INTERACTIONS
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and
close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients
taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and
reserpine).
ADVERSE REACTIONS
Other adverse reactions commonly associated with Lantus® are injection site
reaction, lipodystrophy, pruritus, and rash.
Lantus® is a long-acting insulin analog indicated to improve glycemic control
in adults and children (6 years and older) with type 1 diabetes mellitus and in
adults with type 2 diabetes mellitus. Lantus® should be administered once a
day at the same time every day.
Important Limitations of Use: Lantus® is not recommended for the treatment of
diabetic ketoacidosis. Use intravenous short-acting insulin instead.
Lantus® SoloSTAR® is a disposable prefilled insulin pen.
Please click here for full prescribing information.
CONTRAINDICATIONS
Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive
to Apidra® or any of its excipients.
WARNINGS AND PRECAUTIONS
Closely monitor blood glucose in all patients treated with insulin. Change insulin
regimens cautiously and only under medical supervision. Changes in insulin strength,
manufacturer, type, or method of administration may result in the need for a change
in insulin dose or an adjustment in concomitant oral antidiabetic treatment. As
with all insulin preparations, the time course of Apidra® action may vary by
individual or at different times in the same individual and is dependent on many
conditions, including the site of injection, local blood supply, or local temperature.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Apidra®,
which may be serious.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
All insulins, including Apidra®, can cause hypokalemia, which if untreated,
may be serious.
A reduction in the Apidra® dose may be required in patients with renal or hepatic
impairment.
Apidra® for subcutaneous injection should not be mixed with insulins other than
NPH. Do not mix Apidra® with any insulin when used in the pump or for intravenous
administration. Insulin devices and needles must not be shared between patients.
DRUG INTERACTIONS
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and
close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients
taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and
reserpine).
ADVERSE REACTIONS
Other adverse reactions commonly associated with Apidra® include injection site
reactions, lipodystrophy, pruritus, and rash.
Apidra® is a rapid-acting insulin analog indicated to improve glycemic control
in adults with type 2 diabetes or adults and children (4 years and older) with type
1 diabetes.
When used as a mealtime insulin, the dose of Apidra® should be given within
15 minutes before or within 20 minutes after starting a meal. Apidra® should
normally be used in regimens that include a longer-acting insulin.
Please click here for full prescribing information for Apidra®
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