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Hypoglycemia
Hypoglycemia, or low blood glucose levels, commonly occurs among people with diabetes. Symptoms of hypoglycemia reportedly include dizziness, sweating, pale skin color, sudden moodiness and difficulty paying attention among other symptoms, according to the American Diabetes Association. See below for related articles on hypoglycemia.
Type 2 Diabetes Management in Older Adults
Another advance in semisynthetic insulins has been the development of an insulin analog with basal insulin properties, insulin glargine. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes.
Featured Content from Clinical Geriatrics
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Management of Diabetes Mellitus in the Nursing Home
Management of Diabetes Mellitus in the Nursing Home Management of Diabetes Mellitus in the Nursing Home Abstract Diabetes mellitus affects a large proportion of patients in the nursing home. To date, there are no clear guidelines for optimizing treatment of patients with diabetes in nursing homes. However, the more complicated issues are whether to treat early asymptomatic diabetes in this population and the appropriate intensity of treatment for symptomatic patients with diabetes in the ...
Featured Content from Annals of Long-Term Care
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Efficacy of New Drug Therapies for Diabetes in the Elderly
Oral Agents for the Treatment of Type 2 Diabetes The Table lists the categories of drugs available to treat type 2 diabetes. Glimepiride has a marked insulin secretory effect, both in vitro and in vivo, increasing plasma insulin levels by as much as 50% in patients with type 2 diabetes. Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
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Improving Disease Management with New Treatments for Type 2 Diabetes Mellitus
Insulin resistance leads to a compensatory increase in the circulating insulin level, which overcomes the relative block in insulin action and prevents an increase in glucose levels (Figure 1). Eventually, a defect affecting the secretion of insulin by the beta cell impairs its ability to sustain the heightened level of insulin output required to balance the tissue insulin resistance. When used in combination with drugs that increase insulin levels, including sulfonylureas, repaglinide, or ...
Featured Content from Clinical Geriatrics
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Atherosclerotic Vascular Disease and Diabetes in the Older Adult Part II: Rationale and Strategies for Multi-Interventional Treatment
Part II of this article summarizes treatment guidelines designed to reduce risk and prevent progression of ASVD, and suggests recommendations for their applicability in the older adult population with diabetes. Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial, acarbose was shown to reduce the risk for MI, major CVD, and hypertension.30 Insulin When hyperglycemia is inadequately controlled on oral agents, insulin therapy is indicated regardless of age. SUMMARY Given that diabetes-...
Featured Content from Clinical Geriatrics
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Geriatric Pharmacotherapy Update: New Medications, Recent Releases, and Coming Attractions
Several new therapies were submitted to the FDA for approval in 2004-2005, with an emphasis on agents potentially useful in conditions experienced by older adults. These agents include trospium for overactive bladder, eszopiclone for insomnia, and inhaled insulin, pramlintide, exenatide, and insulin detemir for diabetes mellitus. The mechanism of action, therapeutic application, side effects, and monitoring of these new drugs will be examined here, with some discussion of how they compare to other similar therapies. Additionally, this review will provide considerations for use of these products in older adults where data is available to support conclusive recommendations. Cautious use is recommended with all new medications in older adults, given the limitations of clinical trial data in this special population. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[5]:20-27)
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Diabetes Management in Long-Term Care
Diabetes Management in Long-Term Care Case Report: Diabetes Management in Long-Term Care- Tommy Johnson, PharmD, CDE, CDM, and Tessa C. Tickerhoof, PharmD Click here to download full article in PDF format INTRODUCTION Approximately 1 in 5 skilled nursing facility residents age 55 years and over have been diagnosed with diabetes. Unfortunately, most direct patient care in nursing facilities is provided by nursing aides.2 As a result, diabetes care in skilled nursing facilities is not optimal...
Featured Content from Annals of Long-Term Care
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Impaired Gastrointestinal Motility and Glycemic Control in Patients with Type 2 Diabetes
Although there are very limited clinical data for delayed gastric emptying in elderly individuals, two early studies demonstrated delayed gastric emptying of radiolabeled liquids in elderly patients (mean age, 77 years) relative to younger patients.25,26 IMPACT OF DELAYED GASTRIC EMPTYING ON NUTRIENT AND DRUG ABSORPTION Slowed gastric emptying delays the delivery of nutrients for absorption in the small intestine. Achieving and maintaining glycemic control may also reverse abnormal gastric ...
Featured Content from Clinical Geriatrics
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Oral Agent Treatment of Diabetes Mellitus in Older Adults
Diabetes Treatment Outcomes in Nursing Facility Patients The longest study of diabetes mellitus treatment outcomes in the nursing facility from the current literature covers three years.8 A group of 41 patients were retrospectively divided according to the treatment they received into four groups: oral sulfonylurea hypoglycemic agents and diet (five patients); insulin and diet (25 patients); diet alone (nine patients); and no dietary or drug treatment (two patients). Sulfonylurea Agents in ...
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The Older Patient with Type 2 Diabetes: Special Considerations and Management with Insulin
It is well established that diabetes prevalence in the United States has reached an epidemic level and continues to increase. As the risk for diabetes increases with age, the importance of screening for diabetes among older patients is critical. Once diagnosed, diabetes in older persons must be managed on an individualized basis, according to the underlying comorbidities, level of functioning, and life expectancy of the patient. The health status of patients in older populations varies considerably; for many patients with a higher functional status, tight glycemic control is appropriate. Because these patients can benefit greatly from intensive therapy, it is important to identify and treat these older individuals without unnecessary delay. Treatment to glycemic targets eventually may require insulin therapy, either in combination with oral agents or alone in regimens that approach physiologic insulin secretion (ie, basal-prandial regimens). Caregivers should consider carefully the risks and benefits of insulin therapy for older patients with diabetes on a case-by-case basis, because insulin can safely provide the level of efficacy needed to reach and maintain glycemic targets for many patients. (Annals of Long-Term Care: Clinical Care and Aging 2007;14[11]:17-24)
Featured Content from Annals of Long-Term Care
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