Hypoglycaemia in the Elderly Type 2


Elderly type 2 patients usually have their diabetes complicated by the presence of other co-morbidities. Low blood sugar may be missed in elderly patients and it may be a contributory exacerbating factor in a number of conditions.

Aim of Management

The major goal of diabetes management is usually keeping patients free of risk of the diabetic complications they get from being hyperglycaemic. But in elderly patients perhaps getting low A1c and keeping tight control may put them at greater risk of mortality from hypoglycaemia

As the general population ages, diabetes incidence continues to increase in the elderly. In adults over 65, the prevalence of diabetes is 15.3% and the evidence suggests that more elderly patients are likely to have poor glycaemic control. Type 2 diabetes is less frequent in 40-49 years of age group, but becomes more common in the elderly with nearly half of those with type 2 being over 65.

Treatment of type 2 diabetes in the elderly is influenced by age and life-expectancy, the presence of comorbidities and cardiovascular disease.

Impact of Hypos 

Currently there is not much scientific evidence of the impact of hypoglycaemia in the elderly. Hypoglycaemia affects the elderly just as much as young adults and yet most of the studies have been done in young adults. There are very few studies that have been done on people over the age of 70. It is not known if the glucose limits of hypoglycaemia seen in younger patients equate with hypoglycaemia symptoms in the elderly.

Hypoglycaemia symptoms may be less obvious in elderly patients and thus they may be less aware when their blood glucose levels are low.

Neurological Problems

If elderly patients have cognitive impairment they may be less aware of hypoglycaemia symptoms thus putting them at greater risk of further cognitive impairment as a result of low glucose levels. Similarly, elderly patients may forget the symptoms they need to look out for when they have low glucose levels.

The elderly may also have neurological symptoms such as unsteadiness, difficulty with coordination and visual disturbances that may increase the risk of damage from a hypoglycaemic event.

This lack of clarity of symptoms can cause misdiagnose of hypoglycaemia in the elderly. In some cases, a mental problem or a TIA might be the misdiagnosis of what is actually due to hypoglycaemia. In this scenario, blood glucose levels may not be measured.

Bone Problems

Elderly diabetic patients with osteoporosis or at risk of a fracture need to be carefully monitored. Getting their glucose levels to normal may actually put them at increased risk of a fall.

Conclusion

Keeping glucose levels to near normal levels is the goal for medical management of diabetics. In the elderly, however, treatment should take into consideration not only the standard vascular complications, but also conditions such as cognitive impairment, falls and impaired function.

Conor Caffrey is a writer on health, science and medicine

Other articles by Conor Caffrey about diabetes

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