Lack of Knowledge of Symptoms of Hypoglycaemia by Elderly Diabetic Patients

Abstract

The knowledge of symptoms of hypoglycaemia of 45 consecutive elderly diabetic patients was assessed during a structured interview and compared with that of an age-matched non-diabetic control group. Twenty-three (88%) patients taking oral hypoglycaemic agents (OHAs) and six (32%) insulin-treated patients denied any knowledge of hypoglycaemia. There was no significant difference in knowledge of 14 symptoms of hypoglycaemia between the non-diabetic controls and the combined diabetic (OHA and insulin) groups, but insulin-treated patients were slightly more knowledgeable than patients taking OHAs. Fourteen (54%) of the OHA group were taking either glibenclamide or chlorpropamide which have been associated with severe and prolonged hypoglycaemia. Elderly diabetic patients are unlikely to respond to the warning symptoms of hypoglycaemia and caution should therefore be exercised when prescribing for these patients.

Hypoglycemia in Type 2 Diabetes

“…In elderly people of either sex who have diabetes, unsteadiness and weakness are commonly reported symptoms of hypoglycemia (60), and a group of neurological symptoms affecting vision and coordination have been identified in addition to autonomic and neuroglycopenic symptoms (10,14). Consequently, the manifestations of hypoglycemia in elderly people may be mistaken for other conditions, such as transient ischemic attacks or vaso-vagal episodes.…”

“…Consequently, the manifestations of hypoglycemia in elderly people may be mistaken for other conditions, such as transient ischemic attacks or vaso-vagal episodes. Many elderly people with type 2 diabetes possess little knowledge of the symptoms and treatment of hypoglycemia (60,61). This lack of knowledge extends to their relatives and caregivers (62).…”

Clinical Management of Diabetes in the Elderly

“…They may also have delayed psychomotor responses to intervene in the correction of hypoglycemia. 16 Therefore, each patient's risk for hypoglycemia should be considered, and therapy should be individualized accordingly.…”

Preventing hypoglycaemia: an elusive quest

“…A review of the clinical characteristics of those admitted revealed that half were demented, half were in renal failure, and their average HbA1< was lower than 40 mmol/mol, all of which represent risk factors for hypoglycaemia. The atypical presentation of hypoglycaemia in older adults, which includes nonspedfic symptoms such as weakness, dizziness, sleepiness, unsteadiness, or confusion, continues to be a neglected observation among health professional staff and may account for both a more severe episode developing and delayed treatment resulting in admission to hospital 7 . Such neuroglycopaenic symptoms can be mistaken for cognitive decline, and might be aggravated in older patients who often experience subjective unawareness of hypoglycaemia and an attenuated blood glucose recovery.…”