Hypoglycemia occurs when levels of blood sugar, or glucose, fall too low; a reading below 70 milligrams per deciliter is an accepted definition. It can afflict anyone using glucose-lowering medications to control the condition.
But it occurs more frequently at advanced ages. “If you’ve been a diabetic for years, it’s likely you’ve experienced an episode,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco, who researches diabetes in older adults.
The elder Ms. Larson, 85, has had Type 2 diabetes for decades. Now her endocrinologist and her primary care doctor worry that hypoglycemia may cause falls, broken bones, heart arrhythmias and cognitive damage.
Both have advised her to let her hemoglobin A1c, a measure of average blood glucose over several months, rise past 7 percent. “They say, ‘Don’t worry too much about the highs — we want to prevent the lows,’” the younger Ms. Larson said.
…
Relaxing aggressive treatment can involve stopping a drug, lowering a dose or switching to another medication — an approach called de-intensification.
The advent of effective new diabetes drugs — GLP-1 receptor agonists (like Ozempic) and SGLT2 inhibitors (like Jardiance) — has further altered the landscape. Some patients can substitute these safer medications for risky older ones.
…
[D]e-intensification is proceeding, but too gradually.
A 2021 study of Medicare beneficiaries with diabetes, for instance, looked at patients who had gone to an emergency room or been hospitalized because of hypoglycemia. Fewer than half had their medication regimens de-intensified within 100 days.
“Nursing-home residents are the ones that get into trouble,” said Dr. Joseph Ouslander, a geriatrician at Florida Atlantic University and the editor in chief of The Journal of the American Geriatrics Society.
Another 2021 study, of Ontario nursing homes, found that over half of residents taking drugs for Type 2 diabetes had A1c levels below 7 percent. Those with the greatest cognitive impairment were being treated most aggressively.
Dr. Ouslander has calculated, based on a national study, that roughly 40,000 emergency room visits annually resulted from overtreatment of diabetes in older adults from 2007 to 2011. He thinks the numbers are likely to be much higher now.
https://archive.is/97CZw
…
…