"Hypoglycemia should be avoided in older adults with diabetes. It should be assessed and managed by adjusting glycemic targets and pharmacologic interventions."1 –American Diabetes Association. Standards of Medical Care in Diabetes—2020.
When starting a patient with diabetes on basal insulin
The risk of hypoglycemia is an important safety consideration
"Hypoglycemia should be avoided in older adults with diabetes. It should be assessed and managed by adjusting glycemic targets and pharmacologic interventions."1
–American Diabetes Association. Standards of Medical Care in Diabetes—2020.
Hypoglycemia may be happening more often than you think
Many patients with hypoglycemic events are asymptomatic2

Type 2 diabetes (T2D)
In a study of patients with T2D (n=30),

had unrecognized hypoglycemia as measured by CGMS
Type 1 diabetes (T1D)
In a study of patients with T1D (n=40),

had unrecognized hypoglycemia as measured by CGMS

Talk to your patients about hypoglycemia, and let them know about the risk factors below
Common risk factorsa
- Diabetes treatment (both secretagogues and insulin)3
- Older age1
- Long duration of diabetes4
- Impaired renal function3
aDoes not include all factors that may increase a patient with diabetes’ risk for hypoglycemia.
Medications for cardiovascular conditions may impact hypoglycemia
May increase the risk of hypoglycemia3
- ACE inhibitors
- Angiotensin II receptor blocking agents
May mask the signs and symptoms of hypoglycemia3
- Beta blockers
- Clonidine
Study design
Chico et al study2
Population: Adult patients with type 1 and type 2 diabetes.
Study design: 105 patients with diabetes were included: 75 with type 1 diabetes and 30 with type 2 diabetes. Patients with inadequately controlled type 1 diabetes were randomly assigned to 1 of 2 glucose monitoring systems: 1) a group monitored with a CGMS, or 2) a group that used frequent capillary glucose measurements (the control group).
Study objective: To evaluate the incidence of unrecognized hypoglycemia (glucose value <60 mg/dL) in patients with type 1 and type 2 diabetes, using CGMS.
Safety outcomes trial for adults with T2D and ASCVD
See how Tresiba® U-100 compares with insulin glargine U-100 in risk of MACEb and rate of severe hypoglycemiac
bMACE=cardiovascular death, nonfatal MI, or nonfatal stroke.
cSevere hypoglycemia was defined as an episode requiring assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions and during which plasma glucose concentration may not have been available, but where neurological recovery following the return of plasma glucose to normal was considered sufficient evidence that the event was induced by a low plasma glucose concentration.
ASCVD=atherosclerotic cardiovascular disease; CGMS=continuous glucose monitoring system; T2D=type 2 diabetes.