How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?

Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...

The choice depends on the cause of hospitalization and the patient's food intake. If a patient is not able to eat consistently either due to the illness or due to tests/procedures planned, maintaining with correctional pre-meal boluses is a reasonable choice, understanding that glucose control will ...

Small additions:

1. I always try to remember that the A1C goal for a frail elder is more like 8 (sugars in the 180s). So, for inpatient, I'm aiming for 160-200, especially if PO intake is erratic.
2. Don't forget the patient is only on correctional if you start there - you don't want days of chasing the ...