ReviewReview of Hypoglycemia in the Older Adult: Clinical Implications and Management
Section snippets
Definition and Classification of Hypoglycemia
It is difficult to know the exact prevalence of hypoglycemia (usually defined as blood glucose levels less than 70 mg/dL or 3.9 mmol/L) because many different classifications have been used in studies over the years. In addition, developments in new technologic methods over the past decades have made changes in how hypoglycemia is determined. Traditionally, hypoglycemia was defined as the presence of the Whipple triad, which included 1) low blood glucose; 2) symptoms and signs associated with
Physiologic Responses to Hypoglycemia
In healthy adults, when blood glucose levels fall (usually below 70 mg/dL or 3.9 mmol/L), multiple responses are triggered, and euglycemia is quickly restored. In response to hypoglycemia, insulin secretion from the pancreas will first decrease as the initial response. Next, the pancreas will increase glucagon production as counter-regulation. The liver then detects the decrease in insulin and the increase in glucagon and responds by increasing both glycogenolysis and gluconeogenesis. The
Age-Related Compromise of the Adaptive Responsive to Hypoglycemia
The responses of a healthy adult to hypoglycemia are lost to varying degrees in the adult patient with diabetes and are critically lost in the older population 3, 4. Increased duration of diabetes, as well as the effect of aging on the endocrine, neurologic and cardiovascular systems is additive to the consequences of hypoglycemia in older patients.
Aging has an impact on counter-regulation 5, 6. In healthy older adults without diabetes, glucose counter-regulation by glucagon as well as growth
Consequences of Hypoglycemia in Older Adults
Consequences of hypoglycemia in older adults can be catastrophic. Hypoglycemia can increase the risk for cardiovascular events (4). Acute hypoglycemia in patients can promote QT prolongation, which can predispose patients to life threatening ventricular arrhythmias. There is also a potentially maladaptive vagal response, which only increases the chances for ventricular ectopy (4). It is likely that hypoglycemia is a marker of frailty as well as multiple comorbidities 7, 8.
There is a
Establish appropriate glycemic goals
From clinicians' perspectives, studies from the 1990s pushed the physician community toward tighter glycemic control by demonstrating reduction in long-term complications 12, 13. This practice has led to increased use of insulin earlier in the course of the disease and to increased risk for hypoglycemia. A recent national survey of the older adult population in the United States showed that between 1999 and 2011, the hospital admission rates for hyperglycemia decreased by 55%, while those for
Conclusions
It is challenging to manage diabetes in the elderly population because they may have many associated comorbidities and utilize multiple medications. All elderly patients should be managed with individualized care and treatment plans that include early recognition and management of hypoglycemia. The goals of diabetes management vary based on patients' cognitive and functional capacities, comorbidities and life expectancies. It is imperative to avoid hypoglycemia in the elderly because it may
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Effectiveness of the SUGAR intervention on hypoglycaemia in elderly patients with type 2 diabetes: A pragmatic randomised controlled trial
2023, Research in Social and Administrative PharmacyCitation Excerpt :Other distinguishable adverse consequences of hypoglycaemia that are ageing-driven involve increased frailty, more frequent falls and fractures, and increased risk of disability which reflect on reduced ability to perform daily life activities.29,30 Elderly people suffering from hypoglycaemia are at risk of pronounced neurological decline which would progress to dementia and cognitive dysfunction.31,32 Cognitive impairment in turn would limit the ability to identify and manage low blood glucose levels and self-administration of medications.
Intermittent-scanned continuous glucose monitoring with low glucose alarms decreases hypoglycemia incidence in middle-aged adults with type 1 diabetes in real-life setting
2023, Journal of Diabetes and its ComplicationsCitation Excerpt :Elderly people with diabetes have been shown to be at higher risk for hypoglycemia due to impaired adaptive physiological responses to low glucose levels. These individuals also have comorbidities, such as cognitive loss, that interfere with the prompt identification and/or appropriate treatment of hypoglycemia.28 Therefore, FSL2 with hypoglycemic alarm should be useful to decrease morbidity and mortality associated with hypoglycemia in insulin-treated adults with diabetes.
Self-reported Severe and Nonsevere Hypoglycemia in Type 1 Diabetes: Population Surveillance Through the BETTER Patient Engagement Registry: Development and Baseline Characteristics
2022, Canadian Journal of DiabetesCitation Excerpt :Hypoglycemia is the most frequent acute complication of type 1 diabetes (T1D) and is the main barrier to achieving glycated hemoglobin (A1C) goals (1). Hypoglycemia is burdensome for people with type 1 diabetes (PWT1D) as its symptoms are highly unpleasant (e.g. sudden weakness and blurry vision) and it has physical (e.g. falls and accidents) (2), societal (e.g. driving limitations) (3), and economic (e.g. work-time loss) (4) consequences, as well as negative impacts on mental health and quality of life (e.g. fear of hypoglycemia) (5). The condition is also associated with increased mortality and neurocognitive dysfunction (3).
Development and validation of a prediction model for self-reported hypoglycemia risk in patients with type 2 diabetes: A longitudinal cohort study
2024, Journal of Diabetes InvestigationMetabolic Stress of Red Blood Cells Induces Hemoglobin Glutathionylation
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