In the article, which was published in the March 2018 edition of the Journal of Clinical Endocrinology & Metabolism, authors from the Endocrine Society and Avalere Health, a Washington, DC–based national healthcare advisory firm, analyzed various materials regarding hypoglycemia, including 31 articles, 20 clinical guidance documents, and more than 50 clinician and patient tools. Their aim: to understand the prevalence of hypoglycemic episodes among people with type 2 diabetes and the corresponding health consequences. They report that severe cases of hypoglycemia led to 30,000 emergency room visits among people with both type 1 and type 2 diabetes in 2009. They also reported that in 2010, about 18 percent of Medicare beneficiaries who were hospitalized due to hypoglycemia were readmitted within 30 days, and 5 percent died within that time period. “I’ve been a practicing endocrinologist for 25 years, and I was taken aback by how big a problem this really is,” says Robert Lash, MD, of Washington, DC, the chief professional and clinical affairs officer of the Endocrine Society and the lead author of the paper. RELATED: Treating Type 2 Diabetes From the Inside Out: Tips for Self-Care, Medication, and Insulin In one meta-analysis the authors looked at, researchers observed that people with type 2 diabetes have an average of 23 mild or moderate episodes of hypoglycemia per year, suggesting that despite a lack of firm statistics on such episodes, people with type 2 are certainly affected. “For patients with type 2 diabetes, hypoglycemia doesn’t always rise to the top of the list,” says Dr. Lash, explaining that usually, the goal for these patients is to help reduce high blood sugar levels, or hyperglycemia, which correspond to an elevated A1C, the two- to three-month average of a patient’s blood sugar levels. David Bradley, MD, an assistant professor of endocrinology, diabetes and metabolism at the Ohio State University Wexner Medical Center in Columbus, who was not involved in the analysis, agrees. “The authors bring about a very valid point: that, as practitioners, we have often sacrificed a lowering of A1C and intensive glucose control to lower microvascular complications, without leveraging the risks of hypoglycemia,” Dr. Bradley says. “This has extended to most of our quality care measures that strive for an optimal A1C but do not take into account hypoglycemia.” If you have type 2 or are a doctor treating people with type 2, it’s important to be aware of these risks, as well as the signs and symptoms of very low blood sugar, Lash and his team say. According to the American Diabetes Association (ADA), shakiness, fatigue, rapid heartbeat, and nausea are some signs of hypoglycemia. Particularly, people with type 2 diabetes who are older than 65, on insulin, or taking a class of drugs called sulfonylureas are at the greatest risk for severe hypoglycemia, the authors of the paper reported. The ADA notes that low blood sugar can lead to serious complications such as diabetic coma, seizures, and even death. RELATED: 10 Warning Signs of Low Blood Sugar
What the Findings of the Analysis Mean for Your Health if You Have Diabetes
Bradley points out the article is only a preliminary statement and not a systematic review of scientific literature. But Lash says analyzing the instances of hypoglycemia in people with type 2 diabetes and communicating those findings in this article is the first step in establishing more precise guidelines for detecting and treating these episodes. Generally, hypoglycemia is defined as when blood sugar levels drop below 70 milligrams per deciliter (mg/dl), according to the National Institute of Diabetes and Digestive and Kidney Diseases. However, in their article, Lash and his team propose the following new categories for hypoglycemia to help inform treatment and prevent health complications: If you’re managing type 2 diabetes now and are older, on insulin, or take sulfonylureas, you can help prevent severe episodes of hypoglycemia by making sure you follow your medication regimen, check your blood sugar regularly, and have hard candies or glucose tablets handy in the event that your levels dip too low. And if that happens? “They need to make sure their physician or other provider knows,” Lash says, “because there are things we can do to help reduce the incidence of hypoglycemia while still working towards good control of their diabetes.”
