I recently saw a patient named “Sandra”. She is 85 years old and lives alone. Recently, her daughter called and noticed that Sandra’s voice was slurred. She sounded weak and confused. The daughter dialed 911. Emergency medical technicians found that Sandra had a blood sugar of 28 mg/dL. If her daughter had not called, that low of a blood sugar level could have been deadly. Sandra was hospitalized and stabilized.
Hypoglycemia is the medical term for a blood sugar that is too low
This story is so common that most physicians wouldn’t blink an eye. I see things a bit differently. This should never have happened. Sandra had diabetes and dementia. She lived alone with someone checking in on her daily. Over several years her weight had decreased from 140 to 119. Her hemoglobin A1c was consistently 6.0-7.0. This is a very good lab result in younger diabetic patients. In her, the number was too low. Her diabetes medications were glipizide, 10 mg twice daily, and metformin, 1 gram at bedtime. All the factors combined made her at high risk. It is not at all surprising that she became severely hypoglycemic.
A diagnosis was missed: High risk for hypoglycemia
Sandra had hypoglycemia. That was an easy diagnosis to make. But a diagnosis was missed. Sandra was at high risk for hypoglycemia. As a result, she ended up in the hospital.
Dementia increases the risk for hypoglycemia in patients with diabetes. It is not hard to understand why. In a typical scenario, a patient has a blood sugar level that is considered too high. A physician may decide that a higher dose of medicine or more medicines are needed. The actual problem is that the patient is forgetting to take the medicine regularly. The predictable result of adding medicine is a blood sugar that is too low. A person with memory problems may also take the same medicine too many times. Hypoglycemia is also likely if a patient is losing weight or forgetting to eat.
I stopped the glipizide that Sandra had been prescribed and decreased the metformin from 1,000 mg to 500 mg. Just as important, I talked with her family about the importance of avoiding low blood sugars. They will watch carefully when she takes her medicines. Her appetite and weight need to be stabilized.
Really appreciate this post. How about an additional article for “pre-diabetic older folks— I.e., self care!
Hi Carleen,
Pre-diabetes is an important condition and is definitely something to be concerned about. 37% of the adult US population has pre-diabetes and many of these people will eventually become diabetic. HOWEVER, prediabetes is of greatest concern in young and middle age adults. Conversion from prediabetes to diabetes occurs over time with approximately 50% becoming diabetic over a 5 year time period. Being diabetic at young and middle age is much more likely to have a major impact on health. If a healthy senior is given a diagnosis of prediabetes, the important advice is to live a healthy life style with a healthy diet and plenty of exercise. For a frail elderly patient, a diagnosis of prediabetes definitely needs to be taken with a grain of salt. Prediabetes in a frail elderly patient is unlikely to have impact on overall health.