Preventing + Treating Hypoglycemia in Older Adults with Diabetes

As you age, it’s inevitable that certain aspects of your physical and mental health change—that includes how your body feels during hypoglycemia.

Hypoglycemia—also known as low blood sugar—is when your blood sugar level drops below 70 mg/dL.

If you take insulin or sulfonylureas as an older adult with any type of diabetes, it’s especially important to prevent and manage low blood sugars carefully. Here, we’ll discuss the increased risks, precautions to take, treating severe lows and changes to consider if you’re experiencing frequent lows.

Adjusting diabetes management + goals as you age

In youth and adulthood, your body may have simply felt the symptoms of low blood sugar more easily and sooner. As you age, you become less sensitive and less able to detect these symptoms. Understanding this is critical for older people with diabetes and caregivers.

The overall target blood sugar and A1c targets for older people with diabetes are higher for good reason: your risk of experiencing low blood sugars is not only higher, but it also comes with additional dangers.

Research continues to find reasons why low blood sugars in older adults with diabetes are different and potentially more dangerous compared to other ages.

If you are an older adult with diabetes, or are a caregiver, here are things to consider::

• You are more likely to experience recurring lows.
• You are less likely to recognize and feel the symptoms of lows.
• You are more likely to visit the emergency department for lows.
• Effects of frequent lows can affect your physical and mental independence.
• You are more likely to experience a life-threatening fracture/fall during lows.
• There is a close relationship between frequent lows and general frailty.
• Severe lows increase your risk of serious cognitive and physical decline.
• History of severe lows more than doubles your risk of death.

To reduce your risk of low blood sugars, the Association of Diabetes Care & Education Specialists (ADCES) and American Diabetes Association provides (ADA) the following guidelines regarding time in range (TIR) goals and managing diabetes in older adults:

Remember, of course, that diabetes goals are very personal. Talk to your healthcare team to determine the right goals for you.

Factors that increase your risk of severe hypoglycemia as you age

Frequent low blood sugars (several times per week) should absolutely warrant an urgent appointment with your healthcare team to adjust your medication dosages. Factors that can increase your risk of hypoglycemia as an older adult with diabetes include:

• The length of time you’ve had diabetes
• Using insulin or sulfonylureas
• Inconsistent/unpredictable eating habits
• Disordered eating behaviors, anorexia, etc.
• History of hypoglycemia unawareness
• Recent hospitalization for any reason
• You have any form of autonomic neuropathy
• Experiencing any stage of kidney disease, especially kidney failure
• Managing multiple medications for diabetes
• Managing multiple medications for other conditions
• You consume alcohol on a regular basis
• Struggling with dementia or cognitive decline

Low blood sugars can happen to anyone taking insulin or sulfonylureas, but the older you are, the greater your risk. If these factors apply to you, talk to your healthcare team about adjusting your medications and blood sugar targets to reduce your risk of low blood sugar.

Treating mild low blood sugars as an older adult with diabetes

If you are taking insulin or sulfonylureas to manage your diabetes, you should absolutely be carrying fast-acting carbohydrates with you at all times! Fast-acting carbohydrates are foods that contain no fat or protein because digesting fat or protein slows the breakdown of the carbohydrates that would raise your blood sugar.

Fast-acting carbohydrates include:

• Juice boxes
• Glucose tabs
• A piece of fruit (apple, banana, etc.)
• Skittles, gummy bears, jelly beans
• Maple syrup or honey
• Sugar packets
• Find more fast-acting carbs here

Fast-acting carbohydrates should be stored in a variety of key places, including:

• Your purse or bag
• Your car’s glove compartment
• In pockets, or fanny-pack when walking, exercising, etc.
• Your nightstand
• Your partner’s car
• In the living room, bathroom, etc.

While it may sound excessive to keep fast-acting carbohydrates in every room, the goal is to make them easy to reach during an emergency. Think about the key locations in your home and accessories while running errands that could hold at least 15 grams of carbohydrates.

Using emergency glucagon to treat severe hypoglycemia

Emergency glucagon is a medical tool that can save your life during severe hypoglycemia. Generally, emergency glucagon would be used on you by a caregiver or family member.

Glucagon is a hormone that tells your liver to quickly release stored sugar into your bloodstream. If your blood sugar is so low that you can no longer eat and drink or you’ve lost consciousness and potentially seizing, today’s modern emergency glucagon options, such as nasal glucagon, can be given to you quickly and easily.

However, in some instances for an older adult with diabetes, it may be best for your family member or caregiver to call 911 regardless of having emergency glucagon on hand.

“If a patient with type 2 diabetes is taking insulin, we prescribe emergency glucagon 99 percent of the time,” explains Marcey Robinson, MS, RD, CSSD, CDE, BC-ADM, co-founder of Achieve Health & Performance. “It really depends on the patient’s age, the caregiver’s age and their ability to learn when and how to use glucagon.”

Robinson says many of her patients—and a large percentage of the overall population of people with type 2 diabetes—are at least 70 years old. Using emergency glucagon during the stress of severe hypoglycemia may be more than an older caregiver can handle.

Important to note, however, is that many emergency services in the United States do not carry or are not allowed to use any form of glucagon that requires them to puncture a patient’s skin (like with an auto-injector). Because of this, it is best to still have glucagon on hand so that emergency services personnel can use an individual’s glucagon or help instruct a caregiver on how to use it.

“In certain situations, we tell people and their caregivers to just call 911,” explains Robinson. “Do I like to prescribe it? Absolutely. Is it always going to be the most effective method of handling a severe low blood sugar for older adults? Eh, not necessarily.”

The Bottom Line

Emergency glucagon can save your life when your blood sugar is dangerously low. While calling 911 may be the most appropriate option for certain households caring for a person with diabetes, the glucagon prescription should still be offered, filled and kept in a known location in the home.

It doesn’t matter how much insulin you take or what your A1c is—if you take insulin via pump, syringe, pen, or inhalation, you can experience severe low blood sugar.

• Read more: All About Glucagon
• Read more: Stories About Using Glucagon
• Read more: Asking Your Doctor for Emergency Glucagon
• Read more: Getting Glucagon CoPay Cards & Insurance Denials

Educational content related to severe hypoglycemia is made possible with support from Lilly Diabetes, an active partner of Beyond Type 1 at the time of publication. Editorial control rests solely on Beyond Type 1.

WRITTEN BY Ginger Vieira, POSTED 05/11/22, UPDATED 12/16/22

Ginger Vieira is the senior content manager at Beyond Type 1. She is also an author and writer living with type 1 diabetes, celiac disease, fibromyalgia and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1, Ginger spent the last 15 years writing for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.