Varying insulin use in older hospitalized patients with diabetes.

OBJECTIVE: Observation of insulin use in consecutive hospitalized diabetic older patients in acute care wards with reference to nutritional intakes, measures of functional status, and varying clinical situations. METHODS: Prospective case study in a geriatric medicine ward with CGA, dietary intake measure and used insulin dosage. RESULTS: Among 600 inpatients, 90 diabetic subjects were found. Only 12.2 % diabetic patients had MMSE > 23 and 23.3% were unable to eat without assistance. During the stay 54 patients had received insulin. From admission to discharge or death, doses were 0.39 to 0.19 U/kg (SD 0.41-0.15) during palliative care, 0.43 to 0.45 U/kg (SD 0.20-0.20) in the event of failure of oral therapy, 0.38 to 0.42 U/kg (SD 0.18-0.25) if creatinine clearance was 30 ml/min or lower, and 0.38 to 0.27 U/kg (SD 0.24-0.26) in critical diseases. Dietary intake increased in all during the stay with an energy intake close to 20 kCal/kg/d at discharge, except for those in palliative care, who had a final intake of 8.2 kCal/kg/d (SD 9.1). CONCLUSION: Insulin treatment guidelines adapted to this frail diabetic population are necessary.