Counterregulatory Hormone Responses To Hypoglycemia In Older Adults

Insulin therapy is often problematic for older adults with T1DM and the risk of severe or fatal hypoglycemia associated with the use of insulin increases exponentially with age (44,45). Older adults using multiple medications are likely to have comorbidities and those who are frequently hospitalized are at greater risk for iatrogenic hypoglycemia (46).

Meneilly et al. (44) investigated the effects of age on counterregulatory responses during hyperinsulinemic hypoglycemic clamp studies. They reported that older adults with diabetes had reduced glucagon and growth hormone responses during hypoglycemia, but reported increased epinephrine and cortisol responses when compared to age matched nondiabetic controls. Even with this mixed review, hypoglycemic symptom scores were similar in both the groups at all levels of glycemia (44).

Matyka et al. (46), on the other hand, found differences in hypoglycemic symptom responses when comparing healthy older men, aged 60 to 70, with younger men, aged 22 to 26. During clamp studies, neuroendocrine responses for the two groups were similar. However, symptoms began earlier in the younger men and were more intense (46). Measures of psychomotor coordination deteriorated earlier in the older subjects and to a greater degree (46). The usual 10 to 20 mg/dL plasma glucose difference between the subjective awareness of hypoglycemia and the onset of cognitive dysfunction was lost in the older men (46). This altered counterregulatory effect may contribute to the altered cognitive response to reductions in blood glucose. A lower glycemic threshold to hypoglycemia would be problematic in older persons. This would further limit the time available to self-treat and thereby increasing the risk of developing severe hypoglycemia (44,46). Additionally, in the older patient these neurological symptoms of hypoglycemia may be misinterpreted because of coexisting illnesses such as cerebrovascular diseases or dementia (44,46). In older individuals with diabetes who have comorbidities such as dementia, cerebral vascular accident, or depression, consideration should be given to these confounding factors when considering glycemic treatment goals (46). Polypharmacy or medication nonadherence, impaired renal and/or hepatic metabolism, and poor or erratic nutrition may increase hypoglycemic risks (44,45,47,48). The American Geriatrics Society (AGS) recommends an A1 C of < 7% for older adults in good health and an A1 C of < 8% for older adults with comorbidities and in frail health (47).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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