Key Pathways to Reducing Recurrent Hypoglycemia Risk in Patients with Insulin-Treated T2D

Announcer:
Welcome to Diabetes Discourse on ReachMD. On this episode, sponsored by Lilly, Dr. Rozalina G. McCoy, an endocrinologist, primary care physician, and a National Institutes of Health-funded health services researcher explores pathways to reduce recurrent hypoglycemia risk in patients with insulin-treated type 2 diabetes. Let’s hear from her now.

Dr. McCoy:
So, patients with insulin-treated type 2 diabetes who are at the highest risk for hypoglycemia are patients who have medical complexity. So, comorbidities that make treating their diabetes more difficult or predispose them to otherwise predispose them to hypoglycemia. So, by that, I mean patients who have advanced kidney disease or any stage of chronic kidney disease, advanced liver disease, frailty, functional impairment, or just multi-morbidity in general.

We also think about social determinants of health; so, patients who are struggling with food insecurity in particular, who may not be able to get the food that they need in order to manage their diabetes safely.

And then finally, anything I think in the patient’s life that makes it harder for them to, kind of, appropriately time or adequately time and dose their medications with relationship to when their eating and what they’re eating, as well as their physical activity. So, anyone with unpredictable schedules, whether it’s due to personal needs or their employment makes it very challenging and predisposes them to severe hypoglycemia.

I think it’s really important to be very cognizant about when they take their medications in relation to eating and physical activity. So, making sure that if they are on a mealtime insulin, that they take mealtime insulin before they eat if there’s any planned physical activity that they talk with their healthcare providers about whether that dose needs to be adjusted. But really making sure that their doses are appropriate both in terms of the dose itself and the time that it is administered.

The other thing I really urge all my patients about is that whenever they experience hypoglycemia that they tell their clinician about it. Because if we as clinicians don’t know that a patient is experiencing hypoglycemia, we can’t change their treatment regimen. You know the only way to really prevent hypoglycemia is to understand why it happened in the first place and then take the necessary steps to address those risk factors. Changing glycemic targets alone, for example, is not gonna reduce the risk for hypoglycemia. So, you know, I really encourage my patients to tell me whenever hypoglycemia happens. Even, kind of, mild-to-moderate hypoglycemia because that’s a harbinger of severe hypoglycemia to come.

The other important factor for patients is to know how to recognize and treat hypoglycemic events when they occur. So, you know, really educating patients about early warning signs of hypoglycemia, what blood sugar levels correspond to hypoglycemia because that’s I think for different patients in terms of what their expectation is, what hypoglycemia is. And then you know encouraging really encouraging patients who are at risk for hypoglycemia, which is basically everybody treated with insulin to be checking their blood sugars regularly both on schedule and any time they’re concerned they may be having a hypoglycemic event. So, self-monitoring of blood glucose whether it’s with a finger stick or with a continuous glucose monitor, it’s extremely important.

And then finally, treating hypoglycemia safely and not over-treating because if we overtreat hypoglycemia and then precipitate high blood sugars of hyperglycemia, that can actually lead to a cycle of hypo and hyperglycemia that kind of feeds on itself and patients can really get into a lot of trouble that way. So, knowing how to recognize hypoglycemia, how to treat it appropriately when it happens, and then make sure that patients talk with their clinicians about those events to make sure that, you know, they prevent future events from happening.

Announcer:
This episode of Diabetes Discourse was sponsored by Lilly. To revisit any part of this discussion and to access other episodes in this series, visit ReachMD.com/DiabetesDiscourse, where you can Be Part of the Knowledge. Thanks for listening.