I have always known that hypoglycemia could be fatal. I thought reduced glucose to the brain and body was what caused the shutdown. However, new research published in the May 2014 issue of Diabetes shows that hypoglycemia can cause fatal changes in heart rates (especially in the night), potentially causing a person with diabetes to die in their sleep.
As educators, we talk at length about how long-term hyperglycemia can damage the body and I think we have seen hypoglycemia as more of a short-term problem that is urgent, but not necessarily a condition that can have long-term effects. Described in an article in Healthday, researchers sampled 25 people around the age of 64 with type 2 diabetes, on insulin therapy and who were also at risk of heart disease. They were monitored with a continuous glucose monitor (CGM) and 12-lead Holter monitor for heart rate monitoring.
The researchers found that, “The risk of a slow heart rate was eight times higher when the blood sugar was low at night compared to when it was normal.” What is interesting to note, is that no irregular heartbeats were recorded when the patients actually felt their low blood sugar symptoms. They do not have a definite cause and effect relationship proven but more of an association. In animal studies they have also seen more fatal heart rhythms during hypoglycemia.
We need to work with our patients to achieve safe blood sugar control with individualized goals. If a patient is at an even greater risk for heart disease and is also taking insulin, it is critical that they do not have frequent hypoglycemic episodes. Each episode may be causing abnormal disturbances of the heart placing the patient at higher risk.
Ideally both your type 1 and type 2 patients on insulin should be monitored with CGMs. This gives us the most accurate picture of their blood sugars so we can tailor their treatment and find out if they are having frequent nighttime lows.
We have seen CGMs used more for type 1 patients. Have you used CGMs for your type 2 patients on insulin? Comment below about your experience, especially how it has helped reduce nighttime lows.