Review of Hypoglycemia in the Older Adult: Clinical Implications and Management

Abstract

The aging of the population is a worldwide phenomenon. The prevalence of diabetes rises with increasing age, so the personal and financial costs of diabetes in the aging population have become significant burdens. In 2012, 104 billion (59%) of the estimated $176 billion in United States healthcare expenditures attributable to diabetes were utilized by patients older than 65 years of age [American Diabetes Association (1)]. With improvement in diabetes management and better glycemic control in the general population, there is an increase in the prevalence of hypoglycemia, which is the complication of the treatment of diabetes. Older adults with diabetes have a higher risk for hypoglycemia due to altered adaptive physiologic responses to low glucose levels. These patients also have comorbidities, such as cognitive and functional loss, that interfere with prompt identification and/or appropriate treatment of hypoglycemia. Older adults who suffer from hypoglycemia also have increased risk for falls, fall-related fractures, seizures and comas and exacerbation of chronic conditions, such as cognitive dysfunction and cardiac events. Thus, hypoglycemia in the older adult must be proactively avoided to decrease significant morbidity and mortality. Education of the patients and caregivers is important in prevention and treatment of hypoglycemia. In this article, we discuss the important aspects and unique challenges pertaining to hypoglycemia in older population. We also highlight the risks, consequences and prevention and management strategies for hypoglycemia that can be used by healthcare providers caring for older populations.

Risk factors for hypoglycaemia in in-patients with diabetes treated with continuous insulin intravenous infusion

“…Similar conclusions can be found in recently published papers and recommendations describing the pathophysiology, prevention and management of hypoglycaemia [18,[22][23][24][25][26][27]. Clinical practice also indicates that patients who have had type 1 diabetes for more than 10 years are at the highest risk for hypoglycaemia.…”

Mobile application for diabetes self-management in China: Do they fit for older adults?

“…There is evidence that many apps developers have little or no formal medical training, do not involve clinicians in the development process and may therefore be unaware of patient safety/population specific clinical issues [28–30]. Absence of these functions prevents older adults from being informed about potential risks or gravity of symptoms, putting them at risk for negative health outcomes [31]. Depression shares many symptoms with diabetes, such as fatigue, weight loss and sleep disturbance [27], and is strongly associated with increased burden of diabetes symptoms [32], incurring increased risk of diabetes complications [33].…”

The Psychosocial Challenges and Care of Older Adults with Diabetes: “Can’t Do What I Used To Do; Can’t Be Who I Once Was”

“…Hypoglycemia is usually defined as blood glucose levels less than 70 mg/dL or 3.9 mmol/L. Hypoglycemia is often categorized as major or minor[127]. Major hypoglycemia is defined by life-threatening low blood glucose levels that require third-party assistance.…”

“…Minor hypoglycemia is defined by low blood glucose levels that can be treated with simple sugar; minor hypoglycemia typically presents with signs and symptoms such as tachycardia, blurred vision, and sweating. For many older adults with diabetes, minor hypoglycemia can go unrecognized because it presents with nonspecific symptoms (e.g., lightheadedness, vertigo)[127]. Diminished counter-regulatory responses and changes in pharmacokinetics (e.g., reduced renal elimination) and pharmacodynamics (e.g., increased sensitivity to medications) explain the increased vulnerability of hypoglycemia in older adults with diabetes[128, 129].…”