Hypoglycemia in Diabetes: Challenges and Strategies for Optimal Management

Abstract

Hypoglycemia is a common and potentially serious complication of diabetes management that can hinder optimal glycemic control. It is more frequent in individuals with type 1 diabetes but also affects those with long-standing type 2 diabetes requiring insulin therapy. Hypoglycemia is associated with distressing symptoms, impaired daily functioning, cardiovascular effects, and increased healthcare utilization. Repeated episodes can lead to hypoglycemia unawareness and a diminished counterregulatory response, further increasing the risk of severe hypoglycemia. Healthcare providers must identify at-risk patients and implement preventive strategies. Risk factors include insulin therapy, sulfonylureas, aggressive glycemic targets, altered mental status, impaired cognition, alcohol use, and organ dysfunction. Patient education is crucial for prevention and management, focusing on self-monitoring of blood glucose, recognizing symptoms, promptly treating episodes, and understanding triggers such as exercise, missed meals, and alcohol. Evaluation of hypoglycemia during follow-up visits should assess frequency, severity, and awareness of episodes. Modifying treatment regimens, using continuous glucose monitoring, and involving support systems can help prevent recurrent hypoglycemia. Addressing this often-overlooked complication is essential for ensuring patient safety and optimal diabetes management.