December 24, 2003
Hypoglycemia
Question from Ferrisburgh, Vermont, USA:
My father’s wife is 85 years old and has had two episodes of severe hypoglycemia in the last two days, resulting in ambulance trips to the hospital. She was apparently unaware of what was happening and became incoherent and slow to respond without requesting assistance. Her fingerstick during tonight’s episode was 35 mg/dl [1.9 mmol/L]. She also has angina (with stents) and renal failure. Day-to-day management in this household is complex and very stressful on my dad. There is a visiting nurse that sets up medications every two weeks, including the Lantus (AM dose) and an oral diabetes medication and cardiac meds. She does testing before each meal and takes a sliding scale of I Humalog in the “pen” form.
What is your opinion of any hypoglycemia warning devices that might be available? Would someone of this age and incapacity be a good candidate and which product? I reviewed past questions, but they are dated 1999. I understand Sleep Sentry is back on the market.
Answer:
You might be able to get the GlucoWatch as it is probably available through a physician. However, the big issue is preventing the lows. I would suggest lowering the Lantus. These are the kind of issues you need to make sure her physician is aware of. More monitoring is needed, rather than less. I would also caution against any “sliding scale” insulin at night as this is a risk for a low sugar during the night. The best way to approach this is to intensively monitor the sugars to allow no lows. I would also look at any medications that would sedate her or change her mental status.
JTL
[Editor’s comment: The Sleep Sentry is available. It’s important to note that is senses changes in body temperature and perspiration, which are symptoms of hypoglycemia for some people, but not all.
JSH]