Hypoglycaemia in elderly diabetic patients.

Occurring in the elderly diabetic patients, hypoglycaemia may have serious consequences in terms of morbidity and mortality, but this severe prognosis is nowadays less frequently observed. The clinical manifestations may be somewhat different from those observed in young subjects: symptoms are less frequent, generally neurologic manifestations. The rate of severe hypoglycaemia remains low (about 1.4 episode per 100 patient-years), but increases rapidly in the very elderly and also with insulin therapy, co-morbid conditions especially renal insufficiency, and associated treatments, as well as with unawareness of symptoms. Prevention requires reinforced education for the patient and caregiver, particularly concerning diet, knowledge of signs of hypoglycaemia, and appropriate treatment. Self-monitoring of blood glucose, by the patient when possible, or by a familial or medical caregiver, should be encouraged in order to detect asymptomatic episodes of hypoglycaemia and better adapt antidiabetic treatment.