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Hypoglycemia Discussion May Be Lacking at Doctor Appointments

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Hypoglycemia Discussion May Be Lacking at Doctor Appointments

The possibility of developing hypoglycemia (low blood glucose) is one of the most concerning aspects of living with diabetes for many people. Low blood glucose can develop in response to certain treatments for diabetes, including insulin and sulfonylureas, when these treatments lower your glucose level more than is expected or needed.

Hypoglycemia can cause a range of symptoms, depending on its severity and individual differences — including weakness, shaking, sweating and impaired vision. Far from being just a nuisance, hypoglycemia is a serious condition that can be particularly dangerous if you’re driving a vehicle. But no matter what you’re doing, hypoglycemia can be dangerous and even life-threatening if you don’t or can’t take steps to reverse it, by consuming a quickly absorbed form of carbohydrate like a glucose tablet or gel, or fruit juice.

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If you’re taking a treatment for diabetes that carries a risk of hypoglycemia, it’s essential that you’re aware of the steps you can take to help prevent hypoglycemia from developing — as well as to effectively treat it when it develops. And if your hypoglycemia is frequent or severe, your diabetes treatment plan may need modifications to help reduce this risk.

But according to a new study, many doctors don’t communicate very well about hypoglycemia during appointments with patients — even when patients express their fear of the condition.

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Audio recordings of primary care doctor visits

The study, published in the Journal of General Internal Medicine, examined audio recordings of visits with primary care doctors for patients who used insulin or other diabetes drugs that carry a risk of hypoglycemia. A total of 83 appointments were analyzed, involving eight doctors and 33 patients at a single healthcare practice. These recordings were made as part of a larger study called Achieving Blood Pressure Control Together, which looked at behavioral interventions for hypertension (high blood pressure).

As part of the latest analysis of the audio recordings, researchers made note of discussions about hypoglycemic events or symptoms, guidance to help anticipate hypoglycemia, and hypoglycemia unawareness (hypoglycemia with few or no symptoms). They then compared these aspects of the audio recordings with the doctors’ notes about what was discussed during the appointment.

The researchers found that communication about hypoglycemia events or symptoms occurred in 24% of visits, and patients reported hypoglycemia in 16% of visits. But even though many patients expressed fears related to hypoglycemia, doctors rarely asked about how frequent or severe hypoglycemia was, or what impact it had on patients’ quality of life. Guidance on anticipating or preventing hypoglycemia was provided at 21% of visits. This guidance focused mainly on dietary habits and behavior changes, rather than on how to treat hypoglycemia or make sure you aren’t driving when it’s most likely to occur.

Discussions of hypoglycemia unawareness — which tended to be limited when they did happen — occurred in only 8% of visits. This is notable because in people who experience hypoglycemia unawareness, progression to severe hypoglycemia — including symptoms such as losing consciousness, which requires emergency medical attention to avoid coma or even death — may occur before a person develops significant symptoms.

Compared with the analysis of audio recordings, doctors’ own notes about the visits tended to contain many specifics about the discussions — but also often left out mentioning certain aspects. In other words, doctors’ notes were often specific but incomplete, rather than covering the discussions about hypoglycemia in a more general way.

Study highlights need to discuss hypoglycemia

While this small study at a single location can’t necessarily tell us what’s happening at most primary care doctor visits, it does highlight at least the possibility that many people with diabetes aren’t getting asked detailed questions about their experiences with hypoglycemia. Given how important it is to avoid hypoglycemia, these results point to the need for doctors to ask patients how often they experience hypoglycemia, and how it affects them — and to find ways to reduce the risk of hypoglycemia when necessary.

If you’re concerned that your doctor isn’t asking enough questions about your experiences with — or fears of — hypoglycemia, write a list of concerns you have about hypoglycemia for your next doctor’s appointment. And if your doctor still doesn’t appear to be concerned by frequent, severe or highly disruptive episodes of hypoglycemia, you may want to consider seeking out a different doctor to reevaluate your treatment plan.

Want to learn more about low blood glucose? Read “Understanding Hypoglycemia,” “What Is Hypoglycemia: Symptoms and Treatments” and “Hypoglycemia — What Your Inner Circle Needs to Know.”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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