The constant high blood sugar of diabetes damages the body, harms your health and, in the long term, shortens lives. But blood sugar that’s too low is also dangerous—and can cut life short more quickly. A new study now finds that seniors being treated for type 1 diabetes may be spending more than an hour daily with low blood sugar levels—and a significant part of that time with levels low enough to put them at risk for loss of consciousness, seizures…and even death.

Researchers from 22 sites across the US that are part of the T1D Exchange tracked glucose levels in 203 patients age 60 and older with type 1 diabetes for 21 days. The patients wore a continuous glucose monitor (CGM) to record their glucose levels around the clock.

Results: On average, patients were within a healthy blood glucose target range—defined as 70 md/dL to 180 mg/dL for at least 70% of the day—for only 57% of the day (about 13.4 hours). The rest of the time was spent in a state of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Of particular concern was that many spent about half an hour daily with blood sugar levels low enough to be dangerous. Worse, many of the patients in the study who experienced hypoglycemia did not recognize the warning signs.

Hypoglycemia can cause falls, loss of consciousness, seizures and even death if not treated. Warning signs to look for include blurred vision, confusion, slurred speech, numbness, sweating and shaking, poor coordination, dizziness or feeling light-headed, difficulty concentrating, feeling anxious or irritable, hunger or nausea and erratic changes in behavior. People with diabetes, especially those at risk for hypoglycemia, are educated about the symptoms. However, the symptoms can be mistaken for other health issues—which can mean that hypoglycemia does not get treated.

Most people with diabetes are able to recognize early symptoms and know that they need to eat a glucose snack—such as a sugar tablet or a glass of juice. If they experience severe hypoglycemia, they may need another person to inject them with the hormone glucagon, which raises blood sugar levels. However, many people with diabetes do not know that using insulin, especially for many years, and also having previous episodes of hypoglycemia can cause desensitization to hypoglycemia warning signs, a condition called hypoglycemia unawareness.

Hypoglycemia unawareness is most common among people with type 1 diabetes—an estimated 40% may have the condition. But it can also affect people with type 2 diabetes. Hypoglycemia unawareness increases the risk of slipping into the hypoglycemic danger zone, becoming too confused to eat a sugary snack by themselves…or passing out. In the current study, patients who spent the most time daily with low blood sugar were hypoglycemia unaware.  

Self-Protection If You Have Diabetes

If you are an older person with diabetes on insulin…

• If you are aware of experiencing periods of hypoglycemia, don’t ignore them…and let your doctor know. You may be in the danger zone more often than you realize and may need to take additional steps to better control your blood sugar. Likely periods of increased risk: At night while you’re asleep…before lunch…after drinking alcohol…and after exercise.

• If you find that you don’t always realize when your blood sugar is low (hypoglycemic unawareness), make family members and/or coworkers aware of the signs of hypoglycemia—and, if necessary, alert them that they may need to inject you with glucagon if you aren’t able to. (It’s a good idea to always carry a glucagon kit if you take insulin.) Note: Avoiding hypoglycemia for up to four weeks can restore hypoglycemia awareness.

• If blood sugar control continues to be problematic, talk to your doctor about getting a continuous glucose monitoring system (CGM). A CGM sets off an alarm when glucose gets too low (or too high)…and also tracks periods of hypoglycemia and hyperglycemia so that you can tell how well you’re doing.