Clinical Case Study

Hypoglycemia associated with impaired mobility and diminished confidence in an elderly person with type 2 diabetes

Lauren McCluskey, Olivia Jagger and W David Strain

Diabetic Hypoglycemia June 2014, Volume 7, Issue 1: page 11-14

An elderly lady with type 2 diabetes presented with the complaint of lack of confidence when mobilizing. Although she had experienced a single fall, this had resulted in a disproportionate reduction in her confidence and she described intermittent “dizzy episodes” when walking. The latter were abolished after discontinuation of her sulfonylurea therapy, but rehabilitation to independent life required a period of 7 weeks in hospital. This case highlights indirect consequences of hypoglycemia in older patients, with reduced quality of life and the healthcare cost of an avoidable hospital admission. In such cases, the need for hypoglycemic therapy should be reviewed, in view of the patient’s limited life expectancy and the therapeutic delay between good glycemic control and clinical outcomes. Hypoglycemia in older adults is associated with an increased risk of falls causing injury with fractures, and cerebrovascular events such as stroke. In some, recurrent hypoglycemia may accelerate cognitive decline. The effect of hypoglycemia on quality of life is more difficult to measure. The choice of glucose-lowering agent in the frail elderly person should consider the potential risk of hypoglycemia, rather than achieving glycemic targets.

Keywords: hypoglycemia, sulfonylurea, type 2 diabetes