Is Hypoglycemia Prevalent in Type 2 Diabetes?


You have type 2 diabetes, or know someone with it, so of course, your focus is on high blood sugar, also known as hyperglycemia. It makes sense considering the risks and complications that stem from having high blood sugar over a long period of time.

Probably after your diagnosis, your doctor warned you of diabetes complications, put you on metformin or insulin or both, prescribed you a blood glucose meter and gave you some nutrition tips to manage your blood sugar before sending you on your way.

To treat hypoglycemia, also known as low blood sugar, maybe your physician told you to eat a few glucose tablets or keep a lollipop around. 

If you’re unfamiliar with hypoglycemia, here are some quick facts to know about it. 

  • Hypoglycemia is defined as blood sugar below 3.9 mmol/L70 mg/dL
  • Serious, clinically important, hypoglycemia is defined as blood sugar below 3.0 mmol/L54 mg/dL
  • Severe hypoglycemia results in altered mental and/or physical functioning (cognitive impairment) and can result in unconsciousness or death. Glucagon is a common treatment for people with diabetes who experience severe hypoglycemia. 
  • Some of the signs of hypoglycemia include: 
    • Shakiness 
    • Excessive hunger 
    • Confusion 
    • Fast heartbeat 
  • Risk factors for hypoglycemia are:  
    • Excessive dieting/weight loss
    • Increased age
    • Exercise 
    • Number of years a person has been living with diabetes 
    • Alcohol
    • Insulin usage 
    • Unawareness about hypoglycemia 

But is hypoglycemia prevalent in type 2 diabetes? Is it truly an important issue for people with type 2 diabetes, especially when the primary issue with type 2 is high blood sugar? We’re here to tell you, yeah, it really is. Why? One reason is that it goes underreported and isn’t well documented, but there are others. Keep reading to learn more. 

The Use of Glucose-Lowering Drugs Increase the Chances of Hypoglycemia

When compared to type 1 diabetes, hypoglycemia is seen as a minor obstacle to achieving optimal blood sugar with type 2 diabetes. However, the use of blood  glucose-lowering drugs and their association with hypoglycemia in people with type 2 may be underestimated. Also, the increasing use of insulin to treat type 2 diabetes means cases of hypoglycemia is likely to climb. 

Hypoglycemia Impacts Your Quality of Life

This condition can significantly affect your quality of life—your day-to-day. Hypoglycemia can impact your performance at work, social and family lives. Moreover, it can influence how you perceive hypoglycemia by increasing anxiousness about it. For example, those who are more anxious about it report lower overall, physical and mental health. Furthermore, fear and anxiousness of hypoglycemia and adversely affect glycemic control by causing individuals to purposely cause high blood sugar to avoid the possibility of low blood sugar. 

Economically, severe hypoglycemia is costly. A study showed nearly one in three patients using only basal insulin and one in four patients using basal-bolus insulin were hospitalized at least once due to a severe hypoglycemia episode. In addition to bearing the costs of their hospital visit, they incurred at least $1,116 (62 percent) and $875 (70 percent) more per month than outpatient incidences of severe hypoglycemia. 

Hypoglycemia has Long-Term Physical Consequences

Remember how we listed some of the consequences of severe hypoglycemia earlier? Well, mild and moderate hypoglycemia has long-term health consequences, as well. Experiencing repeated hypoglycemia increases the risk of cardiovascular disease, severe arrhythmias and “dead-in-bed” syndrome. Compared to the general population, people with type 2 diabetes who experience hypoglycemia have a 1.5-2.5 higher risk of developing dementia. 

Some Groups are More At Risk than Others

We’ve covered that people with type 2 diabetes on medications designed to lower your blood sugar are at risk for hypoglycemia. But what about other groups of people? Hypoglycemia is more prevalent for some groups of people with type 2 diabetes than others. It turns out the elderly are at a higher risk for hypoglycemia due to factors like deteriorating kidney function, the usage of multiple drugs that increase the chances of adverse interactions and higher cognitive impairments that come with age. The symptoms of hypoglycemia can become less intense, but elderly individuals are at higher-risk injury and bone fractures, both of which are exacerbated with cognitive impairment. Finally, due to the lack of awareness about hypoglycemia, its symptoms can be mistaken for a mini-stroke or a vaso-vagal episode, also known as a sudden drop in heart rate or blood pressure. 

Other groups at risk for hypoglycemia people with renal failure, also called chronic kidney disease. Some of the reasons for this include the decline of insulin needs and the increased time other diabetes medications remain in the body. 

What Can I Do to Prevent Hypoglycemia?

We know that hypoglycemia is quite prevalent in type 2 diabetes. However, there are steps you can take to prevent, minimize and treat the incidences of hypoglycemia in your life: 

  • Educate yourself and recognize the signs of low blood sugar 
  • Monitor your blood sugar closely, especially during and after exercise. 
  • Keep a disaster plan handy that includes glucagon, in the event of severe low blood sugar.
  • Maintain a balanced diet. 
  • Take your medication as prescribed by your doctor and alert your doctor of any medication-induced low-blood sugar events. 
  • If you’re a health professional such as a caretaker who works with diabetes patients, especially elderly patients, educate yourself on hypoglycemia and when and how to treat them. 

For more information about treating hypoglycemia, read our resource here.

WRITTEN BY T'ara Smith, POSTED 09/25/19, UPDATED 10/10/22

T’ara was diagnosed with type 2 diabetes in July 2017 at the age of 25. Since her diagnosis, she focused her academic studies and career on diabetes awareness and living a full life with it. She’s excited to have joined the Beyond Type 1 team to continue her work. Two years later, T'ara discovered she'd been misdiagnosed with type 2 and actually has latent autoimmune diabetes in adults (LADA). Outside the office, T’ara enjoys going to the movies, visiting parks with her dog, listening to BTS and cooking awesome healthy meals. T’ara holds an MS in Nutrition Education from American University.