A nurse practitioner initiates insulin in a 75-year-old patient weighing 100 kg who is on oral diabetic medications. How much long-acting insulin should be initiated?

In initiating insulin therapy for a 75-year-old patient weighing 100 kg who is already on oral diabetic medications, a cautious approach is necessary to avoid hypoglycemia, especially in an elderly population. The standard guideline for starting long-acting insulin for patients who are insulin-naive typically recommends initiating at a low dose.

Starting with 5 units of long-acting insulin serves as a conservative strategy. This lower dose helps to minimize the risk of adverse effects while providing a foundation for adjusting based on the patient's response and glucose levels. It's important to recognize that in elderly patients or those with potential differences in insulin sensitivity, beginning with a minimal dose ensures safety as the body's response to insulin can vary significantly.

By starting with this lower dose, the healthcare provider can closely monitor the patient's blood glucose levels and titrate the insulin up as necessary, depending on how well the patient's diabetes is controlled and any side effects they may experience. This patient-centered approach is critical in the management of diabetes, particularly in older adults who may have other comorbidities or polypharmacy concerns.