Severe Lows Occur Often in People With Type 2

It is often assumed that people with poorly controlled Type 2 diabetes are not at risk for severe hypoglycemia (low blood glucose), given that their blood glucose levels tend to be high, on average. But according to new research conducted by Kaiser Permanente and the Yale School of Medicine, those who take certain types of diabetes medicines are at risk of dangerous lows whether or not their condition is well controlled.

Hypoglycemia, which may cause symptoms such as shakiness, dizziness, confusion, and sweating, can usually be treated by consuming a fast-acting carbohydrate such as glucose gel or juice. In cases of severe hypoglycemia, however, blood glucose levels drop so low that a person needs assistance to recover, and in extreme cases, hypoglycemia can lead to coma or even death. Medicines including insulin, sulfonylureas (chlorpropamide, glyburide, glipizide, glimepiride, tolbutamide, tolazamide), and meglitinides (nateglinide, repaglinide) all have the potential to cause hypoglycemia.


To determine the association between A1C level (an indicator of glucose control over the previous 2–3 months) and a person’s risk of severe hypoglycemia, researchers surveyed over 9,000 people with Type 2 diabetes who were being treated with glucose-lowering medicines. Participants were placed into one of five A1C categories, ranging from lowest to highest, and asked how many times they had experienced severe hypoglycemia requiring assistance in the previous year.

The researchers found that almost 11% of the respondents had experienced severe hypoglycemia in the previous 12 months and that it had occurred across the entire spectrum of diabetes control. People with the lowest and the highest A1C levels tended to have a higher risk for severe hypoglycemia compared to people with A1C levels in the middle range, but the differences were small and hypoglycemia was common across all five groups. “Poor control is certainly not protective,” the researchers noted.

According to senior study author Andrew Karter, PhD, “Many clinicians may assume that hypoglycemia is not much of a problem in poorly controlled Type 2 diabetes given their high average blood sugar levels. This study suggests that we should pay much closer attention to hypoglycemia, even in poorly controlled patients. Providers should explain the symptoms of hypoglycemia, how to treat it, and how to avoid it — for example, by not skipping meals. Most of all, providers should ask all their diabetic patients whether they’ve experienced hypoglycemia, even those patients with very high average levels of blood sugar.”

The researchers also recommended that evaluations of the quality of diabetes care take into account side effects such as hypoglycemia that are associated with treatment. “While aggressive treatment of high blood sugar was once considered a hallmark of better care, recent clinical trials have raised concerns about the risks of tight control, particularly in the frail and elderly,” Karter stated.

For more information, read the article “Severe Low Blood Sugar Occurs Often in Patients With Type 2 Diabetes” or see the study’s abstract in the journal Diabetes Care. And to learn more cutting down on low blood glucose, read the article “Take a Bite Out of Hypoglycemia,” by certified diabetes educator Gary Scheiner.

  • jim snell

    excellent compelling work and outcomes.

    maybe now the green eyeshade nuts of medicare and insurance industry can be shut down over this idiotic one stip a day or less testing.

    We live in hope!

  • Mary G

    Thank you! Very timely article. I was the victim of an overly zealous doctor. I was a newly diagnosed diabetic with 11.7 A1c. I received insulin, then I was started on metformin which was doubled within a few days. Then she added glipizide. That’s when I started getting 64’s and less and waking up shaking, ravenous, confused, and scared. I did have glucose tablets which addressed the problem. My A1c dropped to 6.8 in less than 2 months. She still was not pleased…wanted to double the glipizide even when my A1c dropped further to 6.1-6.2!!! She really did not care how I was feeling. She was treating to the “lab numbers”. Meanwhile, I was wondering why I was watching what I ate, taking the prescribed meds, exercising, and still ended up having to take the glucose tabs as well. Something was wrong with this picture!!! So, I decided there had to be a better way!!! I started researching all the diabetes treatments available and finally found an approach that worked for me. I now eat low carb, lean protein, little wheat and use stevia, berberine, and other targeted supplements, plenty of water, vegetables, berries, mixed unsalted nuts, no fat plain yogurt, and about 1 ounce of dark chocolate and moderate exercise such as walking. No more meds, no more glucose tabs! My A1c has been in the5.8-5.9 range for the past 7 months and my fasting sugars 84-104. Every diabetic is different, but we need to learn to take charge of our own lives. As the article points out…the “evaluation of quality of diabetes care take into account side effects such as hypoglycemia that are associated with treatment”. When I was first diagnosed, I accepted my doctor’s treatment without question because I was so scared that I had diabetes. That’s why I am glad to see that the “pendalum” is swinging back to a more reasonable approach…away from aggressive treatment. Hopefully this trend will help other diabetics find what works for them and have the backing and support of their doctors!!!

  • Joe

    I’ve been type 2 for 20 years and only experienced a severe low once, while attending an intensive sports training camp (if you’ve seen WWE Tough Enough, this is the kind of thing I’m talking about.) Otherwise no amount of medication or even fasting has ever put me below 89.

  • Archie

    I was diagnosed with Type 2 diabetes in 2008. I used insulin pens, glyburide, and metformin. I had been tested for hypoglycemia four times before that diagnosis, and each came back with the conclusion I was a borderline case as hypoglycemic.

    I had several episodes of hypoglycemia before the diabetes diagnosis, and continue to have problems. Two years ago, I had the Rou-en / Y gastric bypass. My diabetes symptoms (A1C) virtually disappeared three months after the surgery. My weight went from 315 to 214. I get hypoglycemic on average 3-4 times each week. I use glucose tabs and sherbert to address these episodes.

    My glucometer has shown readings like 52, 58, 61 before I treat it. It happens if I skip a meal, exercise, and sometimes even when I sleep. I really dislike waking with these symptoms, as I find it necessary to concentrate on staying awake to address the issue. My doctor says I should probably eat less per meal, but maybe 5 times a day. I take no meds for diabetes now, but my doc cautions me to be vigilant for any other effects of diabetes (foot wounds – ect)

  • JohnC

    The results of this research are not surprising — looking at your A1C as the #1 indicator of your overall control of blood sugar. Remember this is only an ‘average’. You can get some really high and very low readings and still look good on paper.

    The real #1 control is knowing (through experience) what your lows and highs will be depending on what you’re eating and doing, etc. Of course the only way of doing this is by using your Meter at lot until you understand what you’re doing wrong (for you). I aim for very tight control (I use insulin) and yes I am surprised at times… but you learn real fast what is off limits and mistakes become smaller by numbers. A high carb diet never works!

    It is pretty much impossible for your doctor to give you a magic formula. He/she doesn’t live at your house… but I’m sure most believe you are headed for a bad place.

    The biggest setback is the cost of test strips. They don’t need to cost what they do — diabetes is big business :( Good control does mean lots of tests, but so worth it in the long haul.

  • Chopsticks

    Mary G, I had a doctor that was the same way. He had taking three(3) different meds and my feet started to hurt. I could not live that way and figured out which one(diabeta) and we quit taking that one. That was around 2007. Being an over the road driver I have to pay close attention to what my body is telling me at all times. When I was first diagnosed I weighed in around 250 lbs. After having a heart attack(212lbs) in February and heart bypass in April I now weigh 183 pounds. I have to do a stress test Monday so I can complete my physical to drive again. Wish me luck!!

  • Mary G

    Hi Chopsticks…
    Hope you survived your stress test and are on the road again! It’s a tough having diabetes, but as we live and learn it does get a little easier or at least more familiar.
    Congratulations on your weight loss! 67 lbs!!! That was no small matter. Remember to be good to yourself and do some fun things…diabetes is not your WHOLE LIFE!!! Mary G.