Type 1 diabetics often unaware of low blood sugar episodes

When you have type 1 diabetes, keeping track of your blood sugar levels can be challenging. But new research suggests that seniors might really have trouble avoiding low blood sugar, or hypoglycaemia.

In fact, many patients over age 60 may experience up to 100 minutes of a day with low blood sugar and not even know it, the study researchers said.

Hypoglycaemia takes its toll

The bottom line: "Older adults with type 1 diabetes do spend a considerable amount of time in hypoglycaemia," said study author Dr Anders Carlson. He's medical director of the International Diabetes Center in Minneapolis.

"Hypoglycaemia can lead to a lot of severe consequences – loss of consciousness, accidents, falls, hospitalisations and ER visits. Older adults have a higher risk from hypoglycaemia in terms of arrhythmia [irregular heartbeat] that can result in higher cardiovascular problems," Carlson explained.

"Hypoglycaemia can take a toll on people. You have to be ready and able to treat hypoglycaemia at any given moment," he added.

Any blood sugar reading below 70 milligrams per decilitre (mg/dL) is considered low blood sugar. When blood sugar drops below 54 mg/dL, you're at risk for more serious symptoms.

As blood sugar levels dip, you begin to experience symptoms such as shaking, sweating, headache, hunger, fatigue and blurred vision. As blood sugar drops lower, you may feel weak and have trouble concentrating. You may be confused or have changes in your personality. Eventually, untreated low blood sugar can lead to seizures, unconsciousness and even death, according to the US National Institute of Diabetes and Digestive and Kidney Diseases.

Uncomfortable warning symptoms

People who've had diabetes for a long time or who have had repeated low blood sugar are at risk of developing hypoglycaemia unawareness. These people no longer feel the uncomfortable warning symptoms of hypoglycaemia, according to the American Diabetes Association (ADA). This puts them at even greater risk of experiencing serious low blood sugar.

The study looked at 203 adults older than 60 who had type 1 diabetes. More than 90% were white, and just over half wore an insulin pump. Their overall diabetes management averaged within the range recommended for older adults by the ADA.

The participants wore a "blinded" continuous glucose monitor (CGM) for three weeks. Using an extremely thin sensor inserted underneath the skin, CGMs normally provide nearly constant access to blood sugar readings for the patient. The study devices, however, only gave that information to the researchers.

The study found that the volunteers spent an average of 72 minutes a day with blood sugar levels of less than 70 mg/dL and 24 minutes a day at less than 54 mg/dL. Those with hypoglycaemia unawareness spent even more time with low blood sugar levels.

The researchers didn't notice a difference between day and night readings of low blood sugar.

A wake-up call

Dr Joel Zonszein is director of Montefiore Medical Center's Clinical Diabetes Center in New York City, and was not involved with the research. "I'm not surprised by the study. This is what we see all the time now that CGM is becoming more available," he noted.

Zonszein said older people don't have the same counter-regulatory responses from the body that younger people do. That usually means that management of diabetes in older people should be less aggressive, he said.

"Frequent low blood sugars should be a wake-up call to rearrange the diabetes regimen," he said.

Carlson agreed that it was important for treatment to try to minimise hypoglycaemia.

Carlson presented the findings at the Endocrine Society annual meeting, in New Orleans. Research presented at meetings is typically viewed as preliminary until it has been published in a peer-reviewed journal.

Image credit: iStock

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