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Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen
  1. Simon R Heller1,
  2. Mark Peyrot2,
  3. Shannon K Oates3,
  4. April D Taylor4
  1. 1Endocrinology & Metabolism, University of Sheffield, Sheffield, UK
  2. 2Sociology, Loyola University Maryland, Baltimore, Maryland, USA
  3. 3Endocrinology & Metabolism, Indiana University Health Arnett Hospital, Lafayette, Indiana, USA
  4. 4Medical Development, Lilly USA, Indianapolis, Indiana, USA
  1. Correspondence to April D Taylor; taylor_april_dawn{at}


There are many misconceptions about the prevalence and effects of hypoglycemia in people with type 2 diabetes (T2D), including hypoglycemia does not occur or does not have adverse consequences in T2D. This narrative review aims to help dispel these myths. Around 25% of people with T2D taking insulin for >5 years were found to have severe hypoglycemic events, which is comparable to the severe hypoglycemia rate in adults with type 1 diabetes (T1D) diagnosed within 5 years. The total number of hypoglycemic events among insulin-treated T2D, including severe hypoglycemia, is as high or higher than among those with T1D. Recent evidence suggests serious consequences of hypoglycemia may, in some respects, be greater in individuals with T2D, particularly regarding effects on the cardiovascular system. Hypoglycemia is generally patient-reported. Issues with hypoglycemia unawareness, limited glucose testing, limited recall, lack of event logging and fear of failure or shaming limits the number of hypoglycemic episodes reported by people with diabetes. Barriers to healthcare provider inquiry and reporting include lack of knowledge regarding the problem’s magnitude, competing priorities during patient visits, lack of incentives to report and limitations to documentation systems for adequate reporting. All people with diabetes should be encouraged to discuss their experiences with hypoglycemia without judgment or shame. Glucose targets, testing schedules (blood glucose or continuous glucose monitoring) and treatment plans should be reviewed often and individualized to the minimize risk of hypoglycemia. Finally, people with T2D on insulin should always be encouraged to have oral glucose and rescue medication immediately available.

  • hypoglycemia
  • type 2 diabetes
  • insulin
  • prevention

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  • Contributors SRH made substantial contributions to the data interpretation, drafting and critical revision of this work. MP and SKO made substantial contributions to the conception, design, drafting and critical revision of this work. ADT made substantial contributions to the conception, design, data interpretation, drafting and critical revision of this work.

  • Funding This work was funded by Eli Lilly and Company.

  • Competing interests SRH has served as a consultant and on advisory boards for Eli Lilly and Company, Novo Nordisk, Lexicon and Zealand Pharma. SRH reports personal fees from Novo Nordisk and fees for lectures from AstraZeneca. MP reports personal fees and non-financial support from Eli Lilly and Company, Calibra, Novo Nordisk, Lifescan and Valeritas. ADT is an employee of Lilly USA, and a minor stockholder of Eli Lilly and Company.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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