Hypoglycaemia in Type 2 Diabetes and in Elderly People

Abstract

The number of older people with type 2 diabetes is increasing. Ageing modifies the responses to hypoglycaemia, and self-treatment of hypoglycaemia may be compromised by the fact that the glycaemic thresholds for the onset of symptoms and cognitive dysfunction occur almost simultaneously. The morbidity of hypoglycaemia is greater in the elderly, and their presenting features may be misinterpreted, delaying treatment. In type 2 diabetes, counterregulatory responses to hypoglycaemia commence at higher blood glucose levels than in type 1 diabetes. With progressive insulin deficiency, people with type 2 diabetes can develop impaired awareness of hypoglycaemia, as occurs in type 1 diabetes. Hypoglycaemia in type 2 diabetes occurs most frequently with insulin therapy but sulfonylurea-induced hypoglycaemia is also a significant and underestimated problem. In insulin-treated type 2 diabetes, the frequency of hypoglycaemia rises with increasing duration of treatment. People with insulin-treated type 2 diabetes are more likely to require the assistance of emergency medical services to treat severe hypoglycaemia than those with type 1 diabetes.