Simplified Insulin Protocol Using Lantus in Elderly

As patients with diabetes age, adverse social and medical problems may arise. Because of
these problems patients, even those managing their diabetes for many years, find it difficult
to continue with complicated insulin schedules. This may lead to errors in treatment and poor
glucose control. Simplification of treatment has been found to the decrease risk of low blood
glucose, a very dangerous condition at this age. In a previous study, the investigators found
that simplifying treatment did not cause the blood sugars to rise out of control. In this
study, the investigators plan to simplify insulin treatment and monitor for low glucose
episodes with help of a continuous glucose monitor and A1C (measure of average glucose
control over 3 months). The investigators will simplify the treatment by adding glucose
lowering medications that you can take by mouth, in addition to the injection of long acting
insulin called glargine.

Inclusion Criteria:

- Age 70 years or older

- Diagnosis of diabetes mellitus Type II

- At least 2 (short-acting or mixed) insulin injections per day

- At least 1 episode of hypoglycemia (glucose value <70) on screening CGM

Exclusion Criteria:

- Patients with the following illnesses in the past 12 months Myocardial infarction
Angina Coronary artery bypass grafting Percutaneous transluminal coronary angiography
Cerebrovascular event (stroke, TIA)

- Active liver disease (history of cirrhosis or LFT > 3 times normal)

- On dialysis or with severe renal dysfunction (creatinine clearance <20 ml/min)

- Malignancy that limits life span to less than 18 months

- Patients seen in the geriatric clinic who already have simplified regimen as proposed
in the study