Mr. J. is an 86-year-old man who has had type 2 diabetes for 15 years. (This case is a composite based on my experience.) His medications include glipizide 5 mg by mouth daily and 10 units of glargine insulin taken subcutaneously at the same time each night. Since his diagnosis, his glycated hemoglobin (HbA1c) level has usually been in the 7% to 7.5% range. Mr. J.’s wife recently died, and he is now preparing his own meals and eating alone. On a recent trip to his primary care provider, he was found to have lost 8 lbs., but said he was managing well enough by himself. He does not have help at home. One morning, his daughter arrived at his home before lunch and found him confused and diaphoretic. She called 911, and when the emergency medical technicians arrived and tested his blood glucose level, they found it to be 53 mg/dL. He was brought to the ED for care.
Sound familiar? According to the Centers for Disease Control and Prevention (CDC), of the estimated 43 million adults in the United States who are 65 or older, about one in four has diabetes.1 Most of these individuals have type 2 diabetes, which accounts for 90% to 95% of diabetes diagnoses. As the population ages in the coming years, nurses in every type of health care setting will care for older adults with diabetes. Hypoglycemia is a potentially serious complication experienced by older adults with diabetes. From 2006 to 2009, the rate of ED visits for hypoglycemia for adults with diabetes ages 75 or older was almost three times as high as that for middle-aged adults with diabetes