A recent publication in JAMA concluded that those over 80 years old were twice as likely to visit the ED and five times more likely to be hospitalized for severe hypoglycemia than those between the ages of 45 and 64 years old. They estimated that 97,648 ED visits for insulin-related hypoglycemia occur each year and almost one-third result in hospitalization. The most common causes were thought to be reduced food intake and administration of the wrong insulin product. More specifically, an estimated 22.1% of ED visits involved taking the wrong insulin product, and 12.2% involved taking the wrong dose. Of insulin misuse, most frequently there was confusion between long-acting and rapid-acting insulin.
This speaks to one of the more serious adverse drug events that cause harm leading to hospitalization and it’s higher prevalence in the older adult population. It may also suggest that more involvement in the medication management of older adults with diabetes may help reduce the incidence by incorporating safe-medication practices. Factors to assess are: cognitive impairment, visual impairment, setting reasonable blood glucose targets and understanding of matching insulin dose and type with food intake.