7 Questions on Managing Patients with Diabetes at High Risk of Hypoglycemia
The Endocrine Society's 2023 update to guidelines on management of patients with diabetes at high risk for hypoglycemia, the first since 2009, comes in response to a wide range of advances in the field, the authors wrote, including continuous glucose monitoring devices, algorithm-driven insulin pumps, and new glucagon formulations.
The following 7 questions on the guideline recommendations focus on characteristics of hypoglycemia; the utility of technologies to mitigate risk of hypoglycemia; and the distinctions between therapeutic agents for diabetes which can inform selection to reduce the risk for, and hasten the treatment of hypoglycemia.
1. Which of the statements above about hypoglycemia is correct?
Answer: A. An adverse event related to therapeutic management of diabetes. Hypoglycemia occurs in T2D as well as T1D, when treatment includes medications associated particularly low blood sugar levels (eg, insulin, a sulfonylurea), or with particular conditions such as long duration of diabetes, and renal and/or hepatic dysfunction.
2. Match the level of hypoglycemia with the best corresponding characteristic.
Answer: Level 1/C Level 2/A Level 3/B. Level 3 hypoglycemia is a severe event characterized by altered mental and/or physical status requiring assistance.
3. Which of these statements about continuous glucose monitoring is true,which false?
Answer: All statements are false about continuous glucose monitoring. Both real time and intermittently scanned glucose monitoring measure glucose every 1 to 5 minutes, the former automatically transmitting data, the latter requiring the user to scan the sensor.
4. Greater acceptability of CGM systems is the result of improvements that have resulted in which of the above?
Answer: D. All the above. Greater device accuracy, longer duration of use between changing, and less frequent calibration all have increased acceptability of CGM systems for the management of hyperglycemia.
5. Which basal insulin formulation is recommended for adult and pediatric outpatients at high risk for hypoglycemia?
Answer: B. A long-acting insulin analog is recommended for treatment of both adult and pediatric patients with diabetes who are at high risk for hypoglycemia.
6. Which of the above present/s a high risk for hypoglycemia in persons with diabetes?
Answer: C and D. Chronic renal disease and hepatic disease are risk factors for hypoglycemia in patients with diabetes.
7. Which of the glucagon formulations above is/are recommended for outpatients with severe hypoglycemia?
Answer: B, C, and D are recommended. An emergency kit with empty syringe and vial with glucagon solution, an emergency pen with premixed glucagon in solution, or an emergency nasal spray with glucagon powder are preferred over a formulation that requires reconstitution.
Source: McCall AL, Lieb DC, Gianchandani R, et al. Management of individuals with diabetes at high risk for hypoglycemia: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2023;108: 529–562. doi: 10.1210/clinem/dgac596.
