Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities
requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing
and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients
at high risk for hypoglycemia.
Insulin injection errors are essential to recognize and correct at every health encounter. We present an individual who had a medication error related to the dosing administration of his medication pen. This error led to a subtherapeutic response to the treatment of his type 2 diabetes and was not remedied by increasing the dosage or frequency of prescribed insulin to try and obtain efficacy.
Case DescriptionA 58-year-old Caucasian male is followed by his primary care team for management of type 2 diabetes mellitus. He was first diagnosed with type 2 diabetes in 2011, and in early 2019, he was being treated with an oral regimen consisting of metformin 2000 mg per day. The individual had been prescribed an insulin glargine pen by another provider in 2014, but the insulin glargine was stopped at an unknown time before 2019.He was followed by a weight management service from 2017 to 2018 but was discharged after small progress was made, and he was no longer interested in bariatric surgery. No diabetes medications were changed or added by the weight management service. None of these providers were still involved with his care.The primary care provider referred the person to a primary care pharmacist in March
Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities
requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing
and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients
at high risk for hypoglycemia.
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