Diabetes: Precautions and Insulin Use in Elderly
Diabetes is spreading like a
pandemic and has become a major health problem. The condition not only causes
lifestyle issues, a prolonged diabetic condition can lead to various other
health complications such as kidney problems, High BP, vision problems and also
cardiovascular diseases which can lead to fatalities.
For those who are unaware of the
condition and causes of Diabetes, it is a condition under which the blood sugar
levels in our body rise due to non-production or insufficient production of
Insulin by Pancreas. Regular blood sugar level checks at the best
multispecialty hospital in India are required for early diagnosis of such
There are majorly two types of
Type 1 Diabetes
When your immune system destroys
Beta cells in your pancreas that make insulin, the condition is identified as
Type 1 Diabetes. Children and young people are more susceptible to Type 1,
although it can appear at any age. Artificial Insulin doses become necessary
for the survival of the patient affected by this condition.
Type 2 Diabetes
Type 2 is the most common type of
Diabetes. When your body forms a resistance to insulin or there is insufficient
secretion of insulin by Pancreas, the condition is termed as Type 2 Diabetes.
This condition can develop at any age, however, middle-aged and older people
are more prone to develop this condition. One should visit the best diabetes
hospital in India for consultation by a specialist for the diagnosis of
Some times during pregnancy women
become diabetic, this condition usually subsides post-pregnancy. However, women
with Gestational Diabetes are considered more prone to type 2 Diabetes. If you
have suffered from Gestational Diabetes you should go for regular check-ups at
a super-speciality hospital for prevention and control of post-pregnancy
Other types of Diabetes
Monogenic Diabetes- an
inherited form of Diabetes
diabetes – this type of diabetes is caused by excessive mucus formation in
Pancreas affecting Insulin secretion.
In India with the rise in the
aging population, the incidence of Diabetes mellitus type 2 commonly known as
Diabetes is on the rise both in urban as well as rural areas. As described
earlier, Diabetes mellitus is a genetically inherited disease, by the time it
gets manifest; a large number of beta cells which produce insulin get
exhausted. As the age advances the beta-cell exhaustion continues leading to
deficiency of insulin in the body. Along with this other factor like increasing
insulin resistance, obesity, lipotoxicity, lack of physical activities,
presence of co-morbidities & medication also plays a negative role in the
The co-morbidities like COPD
(Chronic obstructive pulmonarydisease, a type of lung disease), cardiac
failure, osteoporosis, osteoarthritis, chronic kidney disease, chronic liver
disease, post-stroke scenario, cognitive impairment & lack of empowerment
at workplace & society reduce the physical activity of the aged population
thereby increasing BMI & reduced GFR also complicate the situation.
At this juncture besides control
of blood sugar, other issues like lipid management, coagulation abnormalities,
lowered immunity, etc. also require attention. All these factors make the
management of Diabetes in the elderly a complex issue. If you are suffering
from comorbidities (health complications apart from diabetes), you are advised
to visit the best multispeciality hospital in India for a comprehensive
check-up, to get a broader perception of your health condition and consultation.
Several issues can be considered
as hindrances in providing proper therapies for diabetes control in the
elderly. While considering various options for diabetes control the points
mentioned below should be considered by diabetic patients and those who show
the pre-diabetic symptoms.
Insulin as an anti-diabetic
therapy through scientifically relevant may get delayed either because of
socioeconomic reasons, prick fear of injections, or the experience of sugar
control with OHAs.
When the sugar levels or HbA1C go
up alarmingly or when complications like CKD, acute infections, ketoacidosis,
need for surgery, failure of OHAs, etc. occur; one considers insulin therapy.
However, the newer antidiabetic drugs (SGLT2 inhibitors) with their multiple
pleiotropic effects may further delay the insulin therapy.
In the elderly, the goals include
control of blood sugars, avoidance of hypoglycemia, care of lipid
abnormalities, prevention of platelet aggregation, care of immune issues &
control of existing comorbidities. In elderly, dental & digestive issues
have also to be considered. Also as per the best diabetes hospital in India,
the goals have to be modified in special situations like fasting &
Artificial Insulin is the
therapeutic agent which is at par with the biologically secreted Insulin as it
replaces the relative deficiency that has occurred in the body. Insulin is the
best option for treating this condition, however, it has side effects like
hypoglycemia & weight gain. But with the constant development of newer
delivery devices, they are now user friendly & have significantly lower
Caution: one should not take any
medicine including Insulin without consulting the best diabetes specialist as
it may further aggravate your situation.
Types of Insulin
There are ultra-short acting
Insulins, short-acting Insulins, intermediate-acting Insulins, premix Insulins
& long-acting/basal Insulins. The insulin prescriptions are always tailor-made
depending upon age, BMI, GFR, food habits, lifestyle, economy, support system,
presence of comorbidities & the present clinical situation. If you are
suffering from diabetes or pre-diabetic symptoms, one must consult a diabetes
specialist at the best multispeciality hospital in India for a customized
Ultra-fast Acting Insulin
They start acting within 1 -3
minutes of injection & lasts for 3 – 4 hours.
The ultra-fast Insulins though
limited but have a special role during surgery & ICU care.
They also become important if the
food habits are not regulated in terms of likes & dislikes of food, timings
& sudden food craving situations.
They are also important if the
postprandial spikes are sharp.
Their action starts within 20 –
30 minutes & lasts for 6 – 8 hours.
They are usually needed if the
food habits are changing or in hospitalized patients where the clinical
scenario keeps changing.
They are also important in pre
& post-surgical times.
Intermediate Acting Insulin
With time their usage is declining.
They are available in various
combinations of short-acting & long-acting insulin. These combinations may
be 25/75, 30/70 & 50/50.
Their selection depends upon the
food habits of the patient.
They are used twice a day or in
select case may be used once a day also.
The long-acting (basal) Insulins
available currently have a “long” duration action (approximately 24 hours) or
“ultra-long’ duration action (approximately 36 – 42 hours), necessitating
injections maybe once every other day.
Newer formulations with
concentrated Insulins (300 IU/ml & 500 IU/ml) are also now available, which
necessitate reduced dosages vis-à-vis 100IU/ml formulations.
These also have relatively better
hypoglycaemic profile especially when it comes to nocturnal hypoglycemia.
Insulin Initiation in elderly
Before starting the Insulin
treatment for elderly patients, a lower dosage should be given rather than the
usual calculation of 0.2 mg/kg body weight, again the dosage and type of
insulin given to the patients should be as per the prescription of a diabetes
specialist only. The patient/ the attendant should spend time educating or
empowering them to titrate the doses also. It is better to remain in touch with
your consultant rather than relying on a fixed chart carrying instructions
given by the best diabetes consultant.
Usually, if patients fasting
blood sugar is >250 mg or post-prandial sugar is >300 mg &/or HbA1C
is >9.5 gm insulin is initiated. These are however not very hard & fast
criteria. The titration of dosage in the case of basal insulin in the elderly
is always gradual & being guided by the fasting sugar levels. The titration
is done every third-fourth day by two units if the desired levels are higher by
Note: Titration is a practice of
quantifying the amount of insulin per dosage.
Insulin in Special
There are certain situations in
which the Insulin therapy requires aggressive monitoring & frequent
adjustments. They include a grossly deranged metabolic state (CKD, CLD,
ketoacidosis), infections, acute coronary & neurological events, surgery,
post-transplant situations & fasting, etc.
Under most of the above
situations, there is an important role of hydration in the body, nutritional
requirement, urinary output, cardiac status & use of other drugs, etc. The
usual choice is multiple dosages of ultra-short acting or short-acting Insulins.
As the clinical scenario changes & the other drugs are either escalated or
deescalated, the insulin requirement also changes. Get in touch with your
diabetes consultant for more information at the best hospital in India.
Metformin & other OHAs may be
used along with insulin therapy. The care is taken in adjusting the dosage
& taking care of hypoglycemia.
GLP 1 agonists are also used
along with insulin in patients with higher BMI.
Lipid-lowering drugs in various
combinations taking care of cholesterol, non-HDL cholesterol &
triglycerides. Aging, Diabetes mellitus & lowered immunity are more or less
equivalents, hence in elderly diabetics, every attempt should be made to boost
the immune functions & prevent infections. Some guidelines advocate the use
of certain vaccines in elderly diabetics, they include pneumococcal vaccine,
influenza vaccine, T-dap vaccine & Herpes vaccine.
There are situations like fasting
& traveling during which insulin dosage requires adjustments.
If one is diabetic or is sensing
diabetic symptoms in their body, they should immediately get in touch with a
super-specialty hospital for a complete check-up to rule out any other factors
for the symptoms before going for diabetes treatment.
We at the metro group of hospitals
are always committed to realizing the vision of providing world class
healthcare at an affordable cost and to achieve excellence in Healthcare
services by offering exceptional care through state of the art technology.
The Metro Group was established
in the year 1997 by Padama Vibhusan, Padma Bhusan and Dr. B C Roy National
Awardee Dr. Purshotam Lal with the vision to provide world-class healthcare
amenities to his countrymen at an affordable cost.
Metro Group of Hospitals are the
leading healthcare centers in our country boasting an ultra-modern
infrastructure providing multispeciality care by an exceptional team of
healthcare professionals under the leadership of world-renowned interventional
cardiologist Dr. Purshotam Lal. We at Metro hospitals provide multispecialty
care for 35 specialties that include Cardiology, Gastroenterology, Nephrology,
Respiratory, Oncology, Orthopaedics Joint replacement, Gastro and Bariatric
Surgery, Neurology and Neurosurgery, etc.
Dr. Purshotam Lal is a
world-renowned cardiologist who has been trained at world’s top medical
institutions in UK, Germany, and USA and has been granted fellowships at
American College of Cardiology; American College of Medicine; Royal College of
Physicians (Canada); Indian College of Cardiology & Society for Cardiac
Angiography Interventions (USA). He has been constantly innovating and has
provided the world with various procedures in the field of Interventional
Cardiology. He has successfully implemented these procedures and has treated thousands
of patients suffering from complex heart diseases.
He made monumental contributions
in clinical development of Monodisc Device and for the first time in medical
history performed Heart Hole (ASD) Closure on a patient from Tamil Nadu. Some
of the other procedure that were performed by Dr. Purshotam Lal for the first
The first case of Aortic Valve
Replacement with Core Valve, without surgery on July 12, 2004.
The 1st case in high-risk Aortic
Valvuloplasty in July 1990 for the 1st time in the Medical Literature.
Introduced INOUE Balloon, the
most popular balloon for opening tight valve, for the 1st time in the country.
Developed a new concept of “METRO
CORONARY SCREENING” for the patients who have been having a phobia of
conventional coronary angiography.
Introduced more than 20
interventional procedures for the first time in the country such as Coronary
Atherectomy, Slow Rotational Angioplasty, Rotablator, etc.
Performing the largest no of
angioplasties/stenting as a single operator in the world – as per HEAL Survey –
the leading health magazine.
His contributions in the field of
interventional cardiology are numerous and he is constantly working to provide affordable
healthcare to all.