Does age effect a person awareness of hypoglycemia?
SUNDAY, NOVEMBER 18, 2012
Take home message from the November 18 post Epinephrine produces the early warning symptoms of a dropping blood sugar. The loss of the epinephrine response to a falling glucose results in " hypoglycemia unawareness " and the progression to the more severe stages of hypoglycemia. I have attached the Nov.18 post below
for your review of some of the physiology associated with hypoglycemia.
Does age effect a persons awareness of low blood sugars ?
The answer is probably yes according to a few articles in Diabetes care*. Zammitt NN, Frier BM . Diabetes Care. 2005; 28(12) 2948-2961 Matyka NN et al. Diabetes care. 1997;20(2) : 135-141
The studies were done comparing non diabetic men age 23 +-3 years to "more mature " men 65 +- 3 years old.
They compared the time lapse from the onset of early warning symptoms of sweating ,shaking ,anxiety to the development of of neurological symptoms , confusion, dizzy, headache weakness , irritability ,belligerent behavior and sleepiness.
Early warning symptoms begin Neurological symptoms begin with Glucose levels with glucose levels
men 23 +- 3 years 65mg/dl ( 3.6 mm/l ) 47 mg/dl ( 2.6mm/l )
men 65 +-3 years 55 mg/dl ( 3.1 mm/l ) 50 mg/dl ( 2.8 mm/l )
It appears that the reaction time available between the onset of early warning symptoms ( Glucose 55mg/dl ) and the onset of neurologic symptoms ( 50 mg/dl ) decreases with advancing age in non diabetic men. ( it is probable the same for men and women with diabetes) This loss of early warning symptoms can also occur within a few years of developing insulin dependent diabetes regardless of age.
Take home message
Older people have , in addition to the decreased awareness of developing hypoglycemia , less time to take corrective measures to treat developing hypoglycemia.
This development can have a major impact on a older persons independence , leading to a change in their living situation and loss of their drivers license.
Short Term vs Long Term Risk
The risk associated with hypoglycemia is immediate , Short Term . Avoiding the risk of hypoglycemia is a major factor in setting A1c target goals . It is good to remember that one benefit of getting older is that long term gets shorter , allowing the slight risk associated with of an A1c between 7 to 8 range to become less important . Have Fun , Be Smart and remember getting a little older does have a few benefits David Calder , MD
Question , Is there an increase in mortality associated with severe hypoglycemia ? The answer tomorrow. My tomorrows have become a little spread out over the last two months because of time constraints of work , buying and remodeling a new home while preparing our current home for sale . For your review _________________________________________________________________________________ NOV. 21 post Does lowering A1c result in increased hypoglycemi...
A few definitions and a little physiology about low blood sugars
Diabetes and the Devil of low blood sugars
I have always felt that people with diabetes have to work a little harder each day to preserve their good health while being forced to walk a narrow path between 2 devils . The Devils of high and the Devils of low blood sugars .The devil of high high glucose comes with known long term risk and the devil of low glucose levels , on the other side of the path , comes with immediate often severe consequences. This is the beginning of a 4 part discussion of hypoglycemia. Today, I will lay the ground work with a few definitions and a little physiology .
The American Diabetes Association's discussion of hypoglycemia. Position statement 2012 "Hypoglycemia is the leading limiting factor in the glycemic management of type 1 and type 2 diabetes.
Mild hypoglycemia - plasma glucose below 70 mg/dl
Severe hypoglycemia -
( where the individual requires the assistance of another person and cannot be treated with oral
carbohydrate due to confusion or unconsciousness) should be treated using emergency glucagon kits)
(In type 1 diabetes and severely insulin deficient type 2 )
These people of lost their awareness of the early warning signals of hypoglycemia
Joslin's Diabetes Mellitus thirteenth edition has a good chart on page 495 . It matches our bodies response and symptoms to decreasing blood glucose levels. I have adjusted the medical terminology slightly to meet the needs of this discussion.
Counter regulatory hormones .
These are hormones our body releases in an attempt to correct a falling blood glucose level. Some of these hormones produce the early warning symptoms that we associate with hypoglycemia.
Glucose level Increase counter regulatory hormone Effects and symptoms
< 70 mg/dl increase glucagon increase in glucose from liver < 70 mg/d/ increase Epinephrine increase glucose, feeling of anxiety, sweating , shaking, pallor
< 65 mg/dl increase cortisol and growth hormone increase glucose levels
Take home message Epinephrine produces the early warning symptoms of a dropping blood sugar. The loss of the epinephrine response to a falling glucose results in " hypoglycemia unawareness " and the progression to the more severe stages of hypoglycemia.
Have Fun , Be Smart and avoid hypoglycemia
Does lowering A1c result in increased risk of hypoglycemia in type 1 and type 2 diabetes ?
Does age effect a persons awareness of hypoglycemia