Hypoglycemia on the Rise

A variety of new diabetes-specific findings were recently unveiled at the 73rd Scientific Sessions of the American Diabetes Association, which took place in Chicago from June 21–25. Included among the new research were two studies indicating that, despite (and perhaps as an unintended consequence of ) national improvements in glucose control, serious hypoglycemia (low blood glucose) is still prevalent in the United States. One-third of people with diabetes currently use insulin, and roughly 90% of those who use insulin have experienced hypoglycemia.


Hospital admission rates for hyperglycemia (high blood glucose) have dropped in recent years, likely due to increasing adoption of intensive glucose control efforts. To determine the effects of intensive control on hypoglycemia-related hospital admission, Kasia Lipska, MD, MHS, and colleagues from Yale examined the health-care records of people with Medicare Fee-for-Service coverage age 65 and older.

The researchers found that from 1999 to 2011, hyperglycemia-related hospitalizations fell in this population by 39.5%. But during the same period, hospital admissions for hypoglycemia rose by 22.3%. Hypoglycemia admissions were two times more common among people age 85 and older compared to those ages 65–74. Black adults were also found to be at a high risk for both hypoglycemia and hyperglycemia admissions.

In a separate analysis, Lt. Commander Andrew Geller, MD, of the CDC, and colleagues looked at data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance and the National Health Interview Survey to determine the number of insulin-related visits to the emergency room from 2007 to 2009.

They found that, of all emergency department visits related to adverse effects from medicine, 6.5% were as a result of insulin. People aged 80 and older were four times as likely as younger people to be hospitalized for insulin-related events. Forty-six percent of the emergency room visits resulted from a failure to eat after injecting insulin, while 22% were as a result of taking the wrong drug (mixing up rapid-acting and long-acting insulins, for example), and 12% were associated with taking the wrong dose of insulin.

Researchers suggested measures such as clearer insulin packaging and an emphasis on educating people about the importance of eating after injecting insulin as ways to lower the rates of severe hypoglycemic episodes.

As Bessie Young, MD, who co-chaired the session in which these studies were presented, noted, this data represents only the most severe cases of hypoglycemia: “People may be seen by paramedics and receive glucose and they’re fine and then never make it to the hospital. So it’s really the tip of the iceberg because so many more patients have hypoglycemic episodes that we don’t even have a clue as to the numbers.”

Because these studies have not yet been peer-reviewed the data should be considered preliminary.

For more information, read the article “ADA: Hypoglycemia Still Poorly Controlled” or see the studies’ abstracts on the official Web site of the 73rd Scientific Sessions. And to learn more about dealing with low blood glucose, read the article “Take a Bite Out of Hypoglycemia: 10 Proven Strategies for Cutting Down on Low Blood Glucose,” by certified diabetes educator Gary Scheiner.

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  • Bonnie Lu Brehm

    Actually no one has ever told me that I should eat right after giving myself a shot of my insulin, the things you learn from just looking at other articles.

    No wonder I’d feel light headed or dizzy and not no the reason why. Go figure.

    Actually I can understand why the older the person is why they get the problem, really now, some can’t read their prescriptions, others just take the drugs or for that matter forget to take their drugs or can’t remember if they did or not. I’m only 61 but if I’m really stressed out, sometimes I can’t remember and I don’t as a rule always prick my finger to see what my readings are, I hate to do that and I’m sure the other folks don’t care to do it either. I’m 61 and know better, but hey I’m fighting this damn disease, I wouldn’t have it if my pa had not overdosed me on my asthma medication. I hold him totally responsible for this unfortunate incident, and if there was some way of getting even I would.

  • Rob Hamilton

    I just started insulin for about 2 weeks now and have expiernced low blood sugar twice at around 55 number. It scares the hell out of me. I do wake up and have oj or a glocose pill or two. I do take my insulin every night at 10:00 before bed. Do you have any suggestions on how not to have these problems. I also take Atripla at bedtime o an empty stomach by order from my doctor. Thankyou.

  • Patricia Taylor

    I had no idea that some diabetics do not know that they must eat if they inject rapid acting insulin. I realize there are not enough endocrinologists to treat all the diabetics but even primary care doctors should tell their patients about Diabetes Education and every diabetic should take the classes when they are diagnozed. I guess I was fortunate to know nothing about diabetes when I was diagnosed and my personality is such that I want to know all about anything that affects me or those for whom I care. The Education Class and a good Certified Diabetes Educator (usually a R.N.) are essential in learning how to care for yourself or your young child after diagnosis. If this is not available, research every medical book, the reliable Internet resources such as the American Diabetes Association (www.diabetes.org). Diabetics first line of defense is education. Hyperglycemia can damage our health and therefore our life style. Hypoglycemia can kill us when it happens! It is not something to be casual about. Ask you doctor about diabetes education. If it is not available, take matters into your hands and find every bit of information you can to help you fight this insidious disease.

  • Jason

    Info for Rob. Had been using glucose tablets for several years to help raise low glucose levels. Have read on this site an have begun to use dried fruit. Works faster and is cheaper. Meaning, blueberries,raisins or cherries. Also try to eat a piece of fresh fruit. Will help with low glucose levels that you are having after taking injections. As I have told my DR and wife, many times that I can feel when my glucose level is low without using my meter.

  • William Dyda

    Hi Rob, I have been a type 1 diabetic for 57 yrs. The only way you can be sure of what your blood sugar is at any time is by testing it. I check my 6 to 8 times a day. I wake up at between 2 & 3 am every morning to check it. Also, when you have tighter control of your blood sugars you will have more of a chance of low blood sugar. So, stay on top it by testing often. I have been on a insulin pump now for about 10 yrs. If you are a type one diabetic you may want to talk to your Dr. or your Diabetic Educator( which you should have one). I hope this has help you somewhat. Take care and good luck. Bill

  • mary lou spann

    yes please be carefull and carry something with you at all times in case of a low some lows can be very severe ive had them — carry something in your cars too– in the purse and in a pocket if you dont carry the purse at all times — keep candy in a candy dish at home and orange juice in the fridge these tips have saved me !!

  • marylittle

    well here adjusting insulin injections again and never knowing what to expect any longer..for instance last week (seven days) the blood sugar drop happened back to back nights for five of those seven days..fortunately i have a great dog to alert me mostly when i am sleeping i also have autonomic neuropathy which caused those symptoms of the low to be non existent thus the dog..i would wish for 55 that i can deal with but mine is dropping when i get to that and it’s like jumping off a cliff ..its just that fast..i became sensitized to basal and can no longer use even a unit of it so i have fast acting bolous on carb count..i hae excellent endos and docs looking out for me but nothing seems to work well last week the readings were down in the low 40s and 30s and once i don’t know because i couldn’t get the meter together..it’s hard when you wake up with your dog watching over you and a half empty bottle of glucose tabs several hours later..i live alone and there are times it is scary for sure..and with back to back like last week..it never lets up because most times it takes me almost 24 hours to recover from the last one

  • Terry

    Bonnie Lu Brehm you should never write something like that. I’m 48 years old and have never heard of such crazy reason for getting diabetes. Most people get it because it is in their blood by just being in wrong family or because there eatting habits are real bad. Maybe your just having a bad day.

  • jackie

    after taking an insulin injection, try to eat protein (cheese, jerky, humus) these metabolise slowly.

  • Lisa

    I do not feel that this is any great news. Just the fact that insurance companies tell the doctor to get their patient’s A1C down is enought to cause the problem. People expect a diabetic to have the A1C as close to 6 as possible, but with a low glucose range you set yourself up for lows. Many people like myself have lost all warning signs of hypoglycemia so it becomes especially scary. It is very frustrating when you watch a commercial and they make it look like all you have to do is test your blood sugar with the “painless” meter and your glucose will be perfect! I understand that good control is essential to not having complications, but please do not be so dumb as to think that it should be surprising that someone’s glucose will be low if that is in fact what you are trying to achieve!

  • John Butterworth

    I tell you why because doctors,who have never had a low blood sugar are changing the numbers of what is low and what is not!! They want the A1c to be 6 or around that!! If I ever get to 6 I would have a low blood sugar 90% of the time!! My wife,a type2, was 77 and her doctor said OH That’s not low!! Fine let’s see how she feels at 77 and then tell me that’s Not Low!! Things have changed and it’s NOT for the better!! 80 to 120 used to be the norm!!!

  • Connie

    I’ve been type 1 diabetic for 56.5 yrs. I’ve been on a pump since they first came out. I’ve experienced lows since the beginning in 1956. I carry carb tablets in my purse & also have raisins on hand at home in case of a low. After baking for a bake sale last Easter, I had leftover icing in a tube. I’ve also found that this works great for treating lows too.

  • Kathy

    Why does everyone assume “you’ll never have to worry about that because you are type II”? Guess what ? It happens more often that you think! And since I’m not on any meds at all, it’s kinda scary when it does happen. I understand most people have insulin or meds causing this. And as to one persons question, people trust their doctors too much, and they don’t know enough to teach their patients. Too often: just take this, see me in 3 months. Call with side effects: can’t be that medicine, or you are taking it wrong. Have no idea there are diabetes educators. Guess what, my insurance won’t pay for one. It’s no wonder, still, that patients have hypoglycemia.

  • pat

    I am not on insulin but I do take oral meds that cause lows and I hate them. Of course to avoid disaster I treat them. Be great if we did not experience then at all.

  • charles lacy

    Ignorance is the co-enemy along with the diabetes.
    Education, education, education and practice, practice, practice to get one on conversational terms is your part of the control team that keeps
    you safe. It is mostly you because you are the one on hand to detect and address. Your PCP is the follow up for analyzing a series of events to see if your meds intake our your living habits need to be modified. You yourself are the major key. Ask your PCP how to best educate yourself.

  • Lee Ann

    I have been a type 1 diabetic for 51 years. I am currently on an insulin pump. I have gotten to the point where some times it is hard for me to recognize my blood sugar is dropping low. I check my sugar four to eight times a day. This helps me to know exactly what my blood sugar is. The most difficult time to know I have low sugar is when I am sleeping. I usually wake up once or twice during the night. I ALWAYS check my sugar at those times. Some times I can wake up because my sugar is low. I keep lemonade in the refrigerator at all times. I drink liquids for treating low sugar because liquids bring my sugar up MUCH faster than solid food. I am more concerned about my low sugar readings than the high ones. I can always treat the high sugar by taking insulin. I’m very scared about the low sugars because I could die from that. One time during the night I woke up and tested my sugar. It was so low that my machine showed “LO.” I checked my book and the “LO” means my sugar was BELOW 20. I was convulsing and alert. (I’ve never had this happen before.) I was SO LUCKY to wake up during the night.

  • Mary G

    I agree with Lisa…five years ago, I was surprised to be diagnosed type 2 after having a stroke. My A1c was 11.7 and my fasting BG was between 278 and 318!!! My hospital doctor started me on 500 mg of metformin and increased it to 1000 mg daily. I also received insulin(only once–against doctor’s orders I found out.) When I got out of the hospital, my PCP (not the same doctor) did not think my BG levels were coming down fast enough(from 176 to 112 within a week)and added glipizide. Within days, my fasting BG was 64! I remember waking up shaking and ravenous, trying to take my blood test every 5 minutes while seeing if the glucose tabs I was taking worked. It was a frightening experience!!! I told my doctor what happened, but she refused to alter my medications. Within two months, my A1c dropped to 6.8 and believe it or not, she still was not happy!!!! I finally figured out she was not really concerned about me–just my co-pays and my BG numbers–which the medical industry keeps adjusting to lower levels!!! Lower is not necessarily better…no wonder hypoglycemia is becoming more common!. I finally switched doctors…but found that they all generally follow established standards of care…”cookie cutter” style..instead of treating us as individuals. Be your own advocate and educate yourself by keeping informed about your type of diabetes from reliable sources so that you can work with your doctor more effectively.

  • Rose Marie B.

    I have found that many of the food products made for the avid hikers and found in the sports stores are great to carry in your purse or car for treating low blood sugar. Glu packets are especially great next to your bed for those night time lows. I sometimes wake up shaky, sweaty, and even unable to communicate ,or navigate out of bed. The Glu in a foil packet is an instant shot to the blood stream where ever you are. It comes in a highly portable foil packet. Very paletlable. The glucose tablets never worked for me. Oj, sugar in milk or water work but aren’t always available. Prefer the healthy food bars or definitely carry Glu packets.

  • julie larson

    I have had type 1 for 25 years. and been on an insulin pump for 7 years. I have been suffering from hypoglycemia unawareness for the last 7 years and have had numerous diabetic seizures that I got a tattoo of a guardian angel dedicated to my 18 year old son for the 1st time he had to call an ambulance when he was 6(I had just been through a divorce). I have suffered memory loss because of these seizures but I have married again to a wonderful man who is vigilant when it comes to my diabetes that I had to share this with someone. not having symptoms for lows is so scary at times. I have a high metabolism and when I get done doing some housework I will test myself and be down in the 30’s. it scares the h3ll out of my husband but it’s so normal for me. I just thank god I have him. thanks for listening.:)

  • GC

    I CARB count and adjust my bolus to my diet i eat at each meal,i did a DAFNE course or Dose Adjustment for Normal Eating http://www.dafneonline.co.uk,There is also one for T2 called X-PERT,The idea of courses is give your self control over your diabetes in self management.Since i attended 4 years ago am glad to say my hypo incidents have dropped dramatically and sympathy with especially with morning dawn,

  • jenny

    I always check the glycemic index food list before eating anything.
    You can download the list for free at http://GlycemicIndexFoodList.info