Prevention and Management of Severe Hypoglycemia in Type 2 Diabetes

Ildiko Lingvay, MD, MPH


November 07, 2022

Severe hypoglycemia is a treatment-related complication of type 2 diabetes (T2D) defined as a low blood glucose level that requires assistance by another person to treat. Although more common in type 1 diabetes, hypoglycemia remains a clinical challenge among T2D patients, according to Dr Ildiko Lingvay of the UT Southwestern Medical Center in Dallas, Texas.

T2D patients treated with insulin or sulfonylureas are among those at highest risk for hypoglycemia, as are those with disease of long duration and hypoglycemia unawareness.

Glucagon remains the established treatment for severe hypoglycemia, but new and recently approved formulations — two pre-mixed autoinjections and an intranasal dry powder — make it far easier for a companion to administer.

Prevention of hypoglycemia remains the optimal strategy, achievable by minimizing use of insulin and sulfonylureas and prioritizing pharmacotherapy with the lowest risk. This strategy favors analog mealtime insulin over human insulins, and the longer-acting basal insulins over older-generation basal insulins. In addition, continuous glucose monitoring is an effective tool to lower hypoglycemia risk.


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