Q&A: Risk Factors, Impact of Hypoglycemia in Patients with Diabetes
A conversation with Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences.
Hypoglycemia is a common diabetes complication and occurs when a patient’s plasma glucose concentration is low. There are numerous risk factors and symptoms of the condition, and it is associated with increased morbidity. In order to prevent episodes of hypoglycemia, educating patients and caregivers on prevention and management is crucial.1
Q&A: Risk Factors, Impact of Hypoglycemia in Patients with Diabetes / WindyNight - stock.adobe.com
In an interview with Drug Topics, Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, discussed the key risk factors for hypoglycemia, what its consequences are on patients with diabetes, and what education programs should emphasize so that people with diabetes and their caregivers can improve the management of hypoglycemia.
READ MORE: Education is Crucial to Prevent Hypoglycemia in Patients with Diabetes
Drug Topics: What are the key risk factors for hypoglycemia and what are its consequences on patients with diabetes?
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP: There are quite a few risk factors. No surprise to anyone, medication use is a big one. Overuse or inappropriate dosing of insulin or sulfonylureas can cause hypoglycemia. Impaired awareness of hypoglycemia due to repeated episodes. Also, dietary issues. People may skip meals or have insufficient carbohydrate intake or irregular mealtime scheduling can cause hypoglycemia. Also, food insecurity and erratic meal patterns. The other thing to consider is physical activity. Any increased or unplanned physical activity without adjusting food intake or adjusting medications can be a risk factor. People often forget about alcohol consumption. Alcohol can actually impair the livers ability to produce glucose. The liver is busy and unable to produce that if someone had consumed a lot of alcohol, and that can actually be delayed. It might not even happen the day of drinking excessive alcohol. It could be the next day or the next day.
Another risk factor might be advanced age, particularly people over 75 years old. If they have cognitive impairments like dementia. Overly strict glycemic control may be especially inappropriate in older adults. Renal or hepatic impairment can be a risk. Slow drug metabolism can cause hypoglycemia risk and social determinants of health, such as inadequate access to healthcare resources can be risk. Some of those consequences, we may think of immediate effects like dizziness or confusion, sweating, rapid heartbeat, seizures, loss of consciousness. But there is also a long term impact. Repeated hypoglycemia episodes may lead to hypoglycemia unawareness and increased risk of severe events cognitive decline, and that impaired awareness of hypoglycemia creates sort of a vicious cycle of more severe events. It also increases the risk of cardiac arrhythmias and cardiovascular disease. That's often forgotten.
Economic and social costs, including absenteeism from work, reduced productivity. In terms of social cost, increasing the use of emergency medical services and emergency department visits and hospitalizations. When people with diabetes and hypoglycemia are not treated in a timely manner, they may suffer really unrecoverable seizures or coma. Severe hypoglycemia events are associated with an increased risk of death, and that can be days to months after they occur.
I actually had a very dear friend pass away from hypoglycemia. So, this is a topic particularly near and dear to my heart. There is an emotional and psychological impact, really a fear of hypoglycemia, and that's both in patients and in caregivers and family members. That can lead to altered behavior and glycemic goals and really decreased quality of life.
Drug Topics: What should education programs emphasize so that people with diabetes and their caregivers can improve the management of hypoglycemia?
Goldman: Preparedness is particularly important. We always want to have patients prepared with fast acting carbohydrates and glucagon readily accessible. Proper medication dosing, consistent meal patterns, with an emphasis on balanced carbohydrates and also adjustments for physical activity. Self-monitoring is important, so emphasizing frequent blood glucose monitoring, and whenever possible, the use of continuous glucose monitoring. Having an action plan ahead of time, so proper timing and administration of fast acting carbohydrates and glucagon if it's needed. Making sure people recognize the symptoms of hypoglycemia. We need to educate people on the different levels of hypoglycemia. Recognizing those symptoms early, so dizziness, sweating, confusion, understanding what to do at that time and avoiding delays. Avoiding not using glucagon when you need it. It should not be reserved for unconsciousness, and that's a critical issue. Anyone who has gotten fast acting carbohydrates and it's failed to bring their blood sugars up, and that is very common, should immediately use glucagon.
We want to make sure that we support the caregivers. We want to train patients on how to use ready to use glucagon, but also train family members and coworkers so everyone knows where it is and how to use it. We want to address any barriers that may be surrounding that patient, combat any stigma around hypoglycemia and encourage open dialog with healthcare providers. We need to make sure patients inform their healthcare providers if they have had an episode of hypoglycemia, so that medications can be adjusted.
READ MORE: Diabetes Resource Center
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