Approach to Managing Hypoglycemia in Elderly Patients with Diabetes

Abstract

Hypoglycemia is a common clinical problem in elderly patients with diabetes. Aging modifies the counterregulatory and symptomatic responses to hypoglycemia. Hypoglycemia in the elderly is not only due to tight blood sugar control, but also due to a multitude of other factors. Hypoglycemia often occurs with insulin, sulfonylureas, or meglitinide therapy. However, other causes may also contribute to hypoglycemia, such as decreased cognition, renal impairment, or polypharmacy. The presenting features of hypoglycemia may be atypical and misinterpreted, resulting in delayed treatment. Morbidity is greater in elderly patients, and the risk of progression to severe hypoglycemia is high because of their altered symptom profile, diminished symptom intensity, and altered glycemic thresholds. Hypoglycemia seems to be the main limiting factor in their glycemic control. In this article we discuss strategies to prevent hypoglycemic episodes.

Diabetes and Aging: Unique Considerations and Goals of Care

“…Age may affect counterregulatory responses to hypoglycemia (20). Avoiding drug-induced hypoglycemia in older adults with type 2 diabetes may also dramatically reduce unnecessary costs (21).…”

Factors associated with hypoglycemia episodes in hospitalized type 2 diabetes mellitus patients in a tertiary health facility in Malaysia

“…Elderly patients are prone to severe hypoglycemia because the aging process modifies the counterregulatory response to become less effective in preventing hypoglycemia. Besides that, elderly patients have attenuated hypoglycemia response and the symptoms are usually present at severe stage of hypoglycemia [26]. Diminished autonomic symptoms such as fatigue and headache leads to late diagnosis of hypoglycemia and therefore elderly patients usually present to the hospitals with severe hypoglycemia [25].…”

Optimal therapy of type 2 diabetes: a controversial challenge

“…Pharmacodynamic changes can cause drug accumulation in the circulation and intensified sensitivity, for instance, to sulfonylureas thus increasing the risk of hypoglycemia [98]. In this setting, aging per se is a strong predictor of hypoglycemia [102-104] and hypoglycemia, in turn, is a major complicating factor of antidiabetic treatment [105]. Impaired counterregulatory response and increased symptom threshold worsen the risk and outcomes of hypoglycemia in elderly diabetic patients [106-107].…”