For a 67-year-old diabetic starting insulin therapy, what should be the initial starting dose?

Starting insulin therapy for a 67-year-old diabetic patient involves careful consideration of both the type of insulin and how it should be incorporated with any existing oral medications. The chosen option involves beginning the patient on long-acting insulin at bedtime while allowing for the continuation of oral hypoglycemic agents.

Long-acting insulin provides a stable baseline level of insulin throughout the day and is beneficial for managing fasting blood glucose levels, which can be particularly important for older adults with diabetes. Initiating therapy with long-acting insulin at bedtime helps to reduce the risk of nocturnal hypoglycemia, as it allows the body to utilize the insulin during the fasting state overnight, maintaining glucose control while minimizing the impact on daily activities.

Continuing oral medications is also important because many patients benefit from the synergistic effect of both insulin and oral hypoglycemics. This approach can gradually transition the patient into insulin management while still using medications that may effectively control postprandial blood glucose levels.

Thus, beginning with a low dose of long-acting insulin, along with ongoing oral medications, is a thoughtful way to introduce insulin therapy, monitoring the patient's response and adjusting dosages as necessary to achieve optimal glycemic control.