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Diabetes Medication in the Elderly

We will discuss about precautions that need to be observed in treating diabetes in the elderly.

The elderly are a special group because time has taken its toll on almost all the major organs of the human body, i.e., there may be a decrease in function on quite a few organs. The elderly are also more likely to have concomitant diseases, which necessitate more drugs, making this group of patients more likely to develop drug-drug interactions.

Because of the likely decrease in the function of the major organs of elimination for most drugs, it is advisable for the elderly diabetic patient to avoid the maximum dose for the anti-diabetic drugs and to increase doses gradually. It is best if we do not go past half the maximum recommended dose for any drug for the elderly. Popular drugs for the elderly include glipizide, and the meglitinides (e.g., repaglinide and nateglinide) of their relatively shorter duration of action.

Beta blockers (e.g., metoprolol, carvedilol, atenolol) are standard treatments for patients with coronary artery disease. For the elderly diabetic patient who takes one of these drugs for his coronary artery disease, this drug will make the patient more likely to suffer the consequences of hypoglycemia (low blood sugar). This is because the diabetic patient will not feel the early symptoms of hypoglycemia such as palpitations, profuse sweating, and tremors when he / she is on a beta blocker. Thus, we tend to miss the chance for early correction and intervention. Insulin and drugs that promote secretion of insulin, alone or in combination with other anti-diabetic drugs, are known to cause hypoglycemia and must be used with caution.

The drugs that increase insulin release into the blood such as sulfonylureas (e.g., glibenclamide, gliclazide, glipizide, glimepiride) and meglitinides and the thia-zolidenediones (e.g., rosiglitazone and pioglitazone), a class of drugswhich increases the sensitivity of our body cells to insulin are eliminated by the liver. Patients with decreased liver function should be cautious in using these drugs. Metformin, another insulin sensitizer, is eliminated by the kidney and should be used with caution in patients who have decreased kidney function. The alpha-glucosidase inhibitors (e.g., acarbose and voglibose), because they are very poorly absorbed, are minimally affected by kidney or liver dysfunction.

Finally, I would like to quote my professor when he gives his lecture on geriatric pharmacology, “start low and go slow”.

This article is written to increase awareness and help the elderly diabetic patient understand the drugs that they are taking. It is still best to consult your friendly neighborhood endocrinologist or clinical pharmacologist for optimal personalized care.

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