The Curbsiders Internal Medicine Podcast #483: Diabetic Dilemmas in Older Adults, Pregnancy and Corticosteroid Use with Jeff Colburn, MD
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May 19, 2025 
Join Dr. Jeff Colburn, an esteemed academic endocrinologist and adjunct associate professor, as he tackles the intricate world of diabetes management. Delve into the unique challenges facing older adults, including medication de-escalation and personalized treatment strategies. Discover the crucial considerations for pregnant women with diabetes, from safe insulin use to postpartum care. Unpack the complexities of steroid-induced hyperglycemia and learn effective insulin management techniques. This conversation is packed with insights to navigate diabetic dilemmas!
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Hypoglycemia Risks in Older Adults
- Older adults with diabetes often lose hypoglycemia awareness due to cognitive dysfunction.
- This increases risk of falls and worsens cognition, making hypoglycemia especially dangerous.
Keep Glucose Accessible Always
- Stock glucose tablets or white sugar packets in every room to treat hypoglycemia quickly.
- Four white sugar packets equal 15 grams of glucose, the target for hypoglycemia treatment.
Prefer Safer Secretagogues
- Avoid sulfonylureas for older adults due to high hypoglycemia risk.
- Use meglitinides or DPP-4 inhibitors as safer insulin secretagogues with lower risk.
