Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes. In patients with type 2 diabetes, severe hypoglycemia has been shown to be the most common acute adverse effect of glucose-lowering therapy.
Hypoglycemia is also associated with reduced cognitive function. Individuals with poor cognitive function have more severe hypoglycemia. A long-term study of older patients with type 2 diabetes demonstrated that individuals with one or more recorded episodes of severe hypoglycemia had a stepwise increase in their risk of dementia.
In the effort to balance the risk for hyperglycemia against that for hypoglycemia, patients must be highly involved in all aspects of their care, including diet, exercise, and medication adherence.
The risk of hypoglycemia typically increases with the duration of insulin use. Five years after the initiation of insulin therapy, the rate of severe hypoglycemia has been reported to reach 35 to 70 episodes per 100 patient-years.
Clinicians must have the knowledge necessary to counsel their patients, who must participate in self-monitoring of blood glucose, be attentive to symptoms of hypoglycemia, and take appropriate action to address hypoglycemia.