Hypoglycemia & the Elderly
HOPE recognizes special population for Hypoglycemia and thus recommends special care and management. Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients' general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences. HOPE is committed to educate patients and caregivers on how to recognize and treat hypoglycemia. A few symptoms of hypoglycemia is older people are as listed below:
- Lack of co-ordination.
- Blurred vision.
- Slurred speech.
Hypoglycemia & Pregnancy
Hyperglycemia is associated with the risk of congenital malformations, birth complication and complications in adulthood. Long duration of diabetes, history of hypoglycemia in the year preceding pregnancy, and fluctuation in glucose levels are the risk factors of severe hypoglycemia during pregnancy. HOPE emphasizes strict glycemic control for pregnancy outcomes. Further, HOPE recognizes major adverse events in pre-existing diabetes and pregnancy for the mother and the foetus. Maternal adversities could range from severe hypoglycemia, DKA, spontaneous abortions, pre-eclampsia/ pregnancy induced hypertension, pre-term delivery and traumatic delivery. Foetal adversities could range from congenital anomalies / malformations, intrauterine growth restriction (IUGR), perinatal mortality (PNM), long-term effects (genomic imprinting) and macrosomia. Lastly, HOPE outlines how to care for pre-existing diabetes and pregnancy; the recommendations include the goal of HbA1c lesser than 7% before pregnancy (corresponding to HbA1c lesser than 6.5% in early pregnancy) in both conditions - without severe hypoglycemia and without high numbers of mild hypoglycemia. Optimizing care and treatment should be a priority.
Hypoglycemia & Children
Hypoglycemia diagnosis and care in very young children is challenging. Three major challenges are - infants and young children are unable to recognize or report hypoglycemic symptoms, they demonstrate irregular eating habits combined with unpredictable periods of exercise, and less strict glycaemic targets and patient-tailored insulin regimens are applicable in this population. HOPE recognizes several negative implications of hypoglycaemia in children; these include selective attention, limited central processing capacity, short-term working memory, spatial long-term memory and poor learning ability. Additionally, early episodes of severe hypoglycemia in children may be associated with impaired problem solving, verbal function, and psychomotor efficiency later in life. HOPE endorses National Institute for Health and Care Excellence (NICE) guideline that suggests continuous glucose monitoring (CGM) for:
- Children with frequent severe hypoglycaemia.
- Children with impaired hypoglycaemia awareness with adverse consequences (e.g., seizures, anxiety).
- Neonates, infants and preschool children.
- Highly active children.
- Those with comorbidities that make BG control difficult.
Hypoglycemia needs to be treated promptly. Although there is no difference in management of hypoglycemia in adults and in children, hypoglycemia in children has negative impact on memory and learning ability. HOPE has identified three population that are prone to hypoglycemia. HOPE aims to create mass patient education; and advocates the right diet and exercise. Further, HOPE emphasized the need for individualizing HbA1c targets and acknowledges its vital role in effective prevention of hypoglycaemic episodes.