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Concerns about hypoglycemia should not deter use of insulin in most patients with type 2 diabetes

Hypoglycemia (low blood sugar) is a significant complication of efforts to control excessively high blood sugar levels among people with diabetes. Mild hypoglycemia causes unpleasant symptoms ranging from sweating, shakiness, hunger, and/or dizziness, but severe hypoglycemia can result in coma, seizures, and death.

Although mild hypoglycemia is common in patients with type 2 (adult-onset) diabetes who are being managed aggressively to lower blood sugar levels, severe hypoglycemia is rare, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09722). Thus, concerns about hypoglycemia should not deter efforts to achieve tight blood sugar (glycemic) control in these patients, concludes Lawrence S. Phillips, M.D., of the Emory University School of Medicine.

Dr. Phillips and his colleagues retrospectively studied 1,055 urban residents (72 percent women; 93 percent black) with type 2 diabetes who had baseline and followup visits at an outpatient specialty diabetes clinic in Atlanta, GA, during 1999. The researchers defined mild hypoglycemia by patient reports of typical symptoms relieved by eating and/or a home-monitored blood glucose level of less than 60 mg/dL. They defined severe hypoglycemia as loss of consciousness or other major change in mental status requiring assistance from another person (for example, ER visit). Twelve percent of patients treated with diet alone had hypoglycemic symptoms compared with 16 percent of those using oral medications alone and 30 percent of those using any insulin (either alone or in combination with a single oral medication).

Overall, one-fourth of the patients suffered from some type of hypoglycemia, but severe hypoglycemia occurred in only five patients (0.5 percent), all of whom were using insulin. Insulin therapy, lower blood sugar level at followup, younger age, and report of hypoglycemia at the baseline visit were independently associated with increased prevalence of hypoglycemia. Thus, patients who are younger or have a lower blood sugar level should be encouraged to be more diligent about meal planning, home monitoring of blood glucose levels, and hypoglycemia symptom awareness, conclude the researchers.

See "Hypoglycemia in patients with type 2 diabetes mellitus," by Christopher D. Miller, M.D., Dr. Phillips, David C. Ziemer, M.D., and others, in the July 9, 2001 Archives of Internal Medicine 161, pp. 1653-1659.

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