Atypical Presentation of Silent Nocturnal Hypoglycemia in an Older Person

Nocturnal hypoglycemia is underdiagnosed in older people with insulin‐treated type 2 diabetes: The HYPOAGE observational study

“…Our study clearly demonstrates that the majority of hypoglycemic events occurs during the night, at a time when SMBG is not performed by patients or caregivers. The occurrence of nocturnal hypoglycemic events is associated with reduced quality of life and long‐term complications, as for day‐time hypoglycemic episodes 28–31 . These nocturnal hypoglycemic events had not previously been recognized in routine care because nocturnal SMBG are not regularly performed and many of these episodes do not waken the person who is affected 28,32 .…”

“…The occurrence of nocturnal hypoglycemic events is associated with reduced quality of life and long-term complications, as for day-time hypoglycemic episodes. [28][29][30][31] These nocturnal hypoglycemic events had not previously been recognized in routine care because nocturnal SMBG are not regularly performed and many of these episodes do not waken the person who is affected. 28,32 Moreover, it has been previously reported that hypoglycemia unawareness is more marked in older compared with middle-aged patients with T2D, 33 putting them at particular risk of severe hypoglycemia.…”

Approach to Managing Hypoglycemia in Elderly Patients with Diabetes

“…The Somogyi phenomenon may also present as nocturnal falls. 40 Subjects who check only their fasting glucose and continue to increase the dose of bedtime insulin are at risk for nocturnal hypoglycemia and the Somogyi phenomenon. Patients with high fasting glucose levels should be encouraged to test during the night at 2 AM or 3 AM to rule out nocturnal hypoglycemia.…”

Managing diabetes in the elderly: go easy, individualize.

“…2,32,33 Hypoglycemia may also present as transient hemiparesis, coma, or falls. 35 We carefully evaluate the glycemic regimen and care environment of any elderly patient who presents with a blood glucose level below 100 mg/dL. The regimen should be altered for less strict control if the patient is cognitively impaired, is at risk of falling, or has an unstable care situation (eg, has irregular meals or needs assistance with daily activities and does not have a regular caregiver).…”