Risk of Hypoglycemia in Type 2 Diabetes
Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dL. This condition is recognized to be one of the main restrictions in achieving normal control in type 1 diabetes. Historically, the risk of hypoglycemia has been considered lower in type 2 diabetes, however, with the increasing use of insulin to treat type 2 diabetes, the occurrence of hypoglycemia has the potential to intensify.
The focus on the relationship between hypoglycemia and type 1 diabetes is due to the frequency of hypoglycemia in these patients. Per the American Diabetes Association, on average, people with type 1 diabetes experience hypoglycemia around twice a week. This number equates to a prevalence of 30% to 40% a year.
It is more difficult to originate equivalent figures for patients with type 2 diabetes because of the diversity. Statistically, the majority of people with type 2 diabetes are middle aged or elderly, and accurate measures of the frequency of hypoglycemia in elderly people are most likely underestimated.¹ In addition to this, when people with type 2 diabetes become insulin deficient, they experience hypoglycemia as frequently as people with type 1 diabetes, and it may go unreported.
Studies behind hypoglycemia and type 1 diabetes show that severe hypoglycemia is reported robustly over a period of one year, and mild hypoglycemia is unreliable after only one week.²,³ Likewise, studies supporting insulin-treated type 2 diabetes report severe hypoglycemia over a period of one year, but the difference is in the results of mild hypoglycemia. Some studies focused on hypoglycemia in type 2 diabetes have overlooked the effects of ageing by selecting middle-aged subjects. The scarcity of elderly people is concerning because this age-group is at the greatest risk of illness as a result of hypoglycemia, especially since their symptoms are often masked and they do not receive prompt treatment.
The frequency of hypoglycemia in type 2 diabetes may not be considered as common as hypoglycemia in type 1 diabetes, but misleading information may have caused this misperception. Hypoglycemia occurs most frequently with insulin therapy, which can occur in type 1 and type 2 diabetes. With the rise in the need of insulin therapy in both illnesses, the risk of hypoglycemia should not be underestimated.
- McAulay V, Frier BM. Hypoglycaemia: Diabetes in Old Age. 2nd ed. Sinclair AJ, Finucane P, Eds. Chichester, U.K., John Wiley and Sons, 2001, p133–152.
- Pramming S, Thorsteinsson B, Bendtson I, Binder C. Symptomatic hypoglycaemia in 411 type 1 diabetic patients. Diabet Med 8:217–222,1991.
- Pedersen-Bjergaard U, Pramming S, Thorsteinsson B. Recall of severe hypoglycemia and self-estimated state of awareness in type 1 diabetes. Diabetes Metab Res Rev 19:232–240,2003.