A 93-year-old male was urgently admitted to our hospital with
dyspnea and disturbance of consciousness. The patient had been visiting a general physician regularly for ten years, for treatment of
type 2 diabetes. He had been treated with
glibenclamide and
voglibose, until
voglibose was replaced with
buformin 3 months before admission. During pre-admission treatment, his HbA1c was 10-12% and serum Cr level was around 2mg/dL, but
insulin therapy had never been considered because of "being too old". The patient had started taking
furosemide one year before admission, because of
edema of the lower legs, and also
spironolactone two months before admission.
Anorexia had continued for one month before admission on May 29, 2003. On admission, his laboratory data were;
blood glucose 87mg/dL, HbA1c 12.5%, BUN 75mg/dL, Cr 3.9mg/dL,
lactate 253.1 mg/dL, and blood gas analysis; pH 6.97, anion gap 45.3mmol/L breathing room air, suggesting marked
lactic acidosis with
renal failure.
Intensive care with
bicarbonate and
fluid therapy was successful, and his
glycemic control improved markedly with
insulin. On the other hand, his activity of daily living (
ADL) severely deteriorated while in hospital Home follow-up was therefore not indicated, and he had to change a hospital for further follow-up. This case report gives rise to the question of how we should manage diabetes in the oldest elderly, including the use of
insulin and
biguanides. In addition, complications of
biguanides in the elderly are reviewed.