Better ways to avoid low blood sugar in people with diabetes offered


A new guideline aims to inform doctors about how best to use the latest medications and technologies to lower the risk of episodes of dangerously low blood sugar, or hypoglycemia, in people with diabetes. Photo by Steve Buissinne/Pixabay

Dec. 7 (UPI) — A new guideline aims to inform doctors about how best to use the latest medications and technologies to lower the risk of episodes of dangerously low blood sugar that may cause seizures or loss of consciousness in people with diabetes

Among its key recommendations is prescribing easier-to-use formulations of glucagon, a peptide hormone that raises the concentration of glucose in the bloodstream, for people with severe hypoglycemia.

It also calls for using continuous glucose monitoring, rather than self-monitoring blood glucose by fingerstick, for patients with Type 1 diabetes who receive multiple daily injections.

The clinical practice guideline was published online Wednesday in  The Journal of Clinical Endocrinology & Metabolism, a publication of the Endocrine Society. It will appear in the journal’s March 2023 print issue.

“The guideline addresses one of the most common issues dealt with by people with diabetes,” Dr. David C. Lieb, co-chair of the panel that wrote it, told UPI.

“Hypoglycemia is costly, leading to ER visits, prolonged hospitalizations and lost time at work. It is a source of much anxiety and distress for people living with diabetes,” and the new recommendations will result in better care for the many people with diabetes who are at risk for it, Lieb, an endocrinologist, said in an email.

Lieb is professor of internal medicine and program director of the Endocrinology, Diabetes and Metabolism Fellowship Program at Eastern Virginia Medical School in Norfolk, Va.

“Type 1 and Type 2 diabetes are very common — 537 million people worldwide, and 37 million in the U.S. — and hypoglycemia affects everyone that treats their diabetes with insulin,” Lieb said.

That includes everyone with Type 1 diabetes, and up to one-fourth of people with Type 2 diabetes, as well as people with type 2 diabetes who take certain common oral medications, he said.

Hypoglycemia is identified as one of the top three preventable adverse drug reactions by the Department of Health and Human Services, the Endocrine Society said in a news release.

The guideline discusses new and better ways to both prevent and treat low blood sugars, and addresses preventing and treating low sugars in multiple settings — including in the outpatient setting and in the hospital, Lieb said.

He described it as a “significant update” from the Endocrine Society’s 2009 guideline on hypoglycemia, explaining it was warranted because of medical advances since then.

That includes new technologies that can more accurately identify persons as risk for hypoglycemia — including new continuous glucose monitor technology — and also new insulin pumps that can help to reduce that risk, Lieb said.

He added that the new forms of glucagon, a primary treatment for severe hypoglycemia, are much easier to administer than what was available in the past.

Also, Lieb said, the 2009 guideline focused on all forms of hypoglycemia, which can occur in people without diabetes, as well as in those with diabetes.

But it is recognized that hypoglycemia and its evaluation in people without diabetes “is, in many ways, very different than what is seen in people with diabetes,” he said.

Hypoglycemia in people without diabetes is “much less common,” and may occur in some people following bariatric surgery, or arise in people with rare types of tumors of the pancreas that inappropriately make the hormone insulin, Lieb said.



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