Skip to main content
SpringerLink
Log in

Hypoglycaemia in Elderly Patients with Diabetes Mellitus

Causes and Strategies for Prevention

  • Therapy In Practice
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Achieving target glycaemic goals while avoiding hypoglycaemia is a major challenge in the management of elderly patients with diabetes mellitus. Repeated episodes of hypoglycaemia may cause extreme emotional distress in such patients, even when the episodes are relatively mild. Moreover, evidence is mounting that hypoglycaemia among elderly patients is a very real and costly health concern. The strongest predictors of severe hypoglycaemia in the elderly are advanced age, recent hospitalisation and polypharmacy. Education is the key to preventing recurrent or severe hypoglycaemia. As such, there should be close coordination of care between the patient, physician and all other healthcare providers in identifying the cause of hypoglycaemia in elderly patients, and appropriate steps should be taken to prevent further episodes. Prevention of hypoglycaemia has the potential to improve psychosocial aspects of elderly health, including enhanced quality of life, boosted confidence, improved compliance with antidiabetic regimens and avoidance of long-term complications.

Since the elderly population represents a unique group, it is imperative to focus on the aetiologies that are exclusive to this group. Advanced age itself is a risk factor for hypoglycaemia, and elderly patients with comorbidities are at increased risk when they are hospitalised. Elderly patients with diabetes often have compromised renal function, which intereferes with drug elimination and thus predisposes them to prolonged life-threatening hypoglycaemia. In addition, patients on five or more prescription medications are prone to drug-associated hypoglycaemia. Although sulfonylurea-associated hypoglycaemia is common, drugs such as ACE inhibitors and nonselective β-adrenoceptor antagonists can also predispose patients to hypoglycaemia. Greater attention should be paid to the avoidance of hypgolycaemia in nursing home residents. Recurrent hypoglycaemia in elderly patients is not only detrimental to achieving good glycaemic control, it is also a substantial economic burden.

Once the causes of hypoglycaemia have been identified, it is crucial to formulate and institute a prevention plan. Firstly, global evaluation of the patient should be carried out to identify possible predisposing risk factors. Secondly, target glycaemic goals should be tailored to each patient. Thirdly, selection of antidiabetic agents should be judicious, then patients and family should be educated to recognise and treat hypoglycaemia. Finally, coordinated care should be provided to identify, treat and prevent hypoglycaemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Fig. 3
Table II
Table III
Table IV
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care 1993; 16(4): 642–52

    PubMed  CAS  Google Scholar 

  2. Harris MI. Epidemiological correlates of NIDDM in Hispanic, Whites and Blacks in the US population. Diabetes Care 1991; 14(7): 639–48

    Article  PubMed  CAS  Google Scholar 

  3. Rockwood K, Await E, MacKnight C, et al. Incidence and outcomes of diabetes mellitus in elderly people: report from the Canadian study of health and aging. CMAJ 2000; 162(6): 769–72

    PubMed  CAS  Google Scholar 

  4. Teuscher AU, Reinli K, Teuscher A. Prevalence of diabetes mellitus and impaired glucose in elderly European subjects. Diabetes 1999; 48Suppl. 1: 395–6

    Google Scholar 

  5. Bertoni AG, Krop JS, Anderson GF, et al. Diabetes-related morbidity and mortality in a national sample of US elders. Diabetes Care 2002; 25: 471–5

    Article  PubMed  Google Scholar 

  6. Krop JS, Powe NR, Weller WE, et al. Patterns of expenditures and use of services among older adults with diabetes: implications for transition to capitated managed care. Diabetes Care 1998; 21: 747–52

    Article  PubMed  CAS  Google Scholar 

  7. Holstein A, Plaschke A, Egberts EH. Incidence and costs of severe hypoglycemia. Diabetes Care 2002; 25: 2109–10

    Article  PubMed  Google Scholar 

  8. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329: 977–86

  9. The UKPDS Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53

    Article  Google Scholar 

  10. Cryer PE, Gerich JE. Hypoglycemia in insulin-dependent diabetes mellitus: interplay of insulin excess and compromised glucose counterregulation. In: Porte D, Sherwin RS, editors. Ellenburg and Rifkin’s diabetes mellitus: theory and practice. 5th ed. Stamford (CT); Appleton and Lange, 1997: 745–60

    Google Scholar 

  11. Herbei G, Boyle PJ. Hypoglycemia: pathophysiology and treatment. Endocrinol Metab Clin N Am 2000; 29: 725–43

    Article  Google Scholar 

  12. Pardridge WM. Brain metabolism: a perspective from the blood-brain barrier. Physiol Rev 1983; 63(4): 1481–535

    PubMed  CAS  Google Scholar 

  13. Pardridge WM, Boado RJ, Farrell CR. Brain-type glucose transporter (GLUT-1) is selectively localized to the blood brain barrier: studies with quantitative western blotting and in situ hybridization. J Biol Chem 1990; 265: 18035–40

    PubMed  CAS  Google Scholar 

  14. Borg MA, Sherwin RS, Borg WP, et al. Local ventromedial hypothalamus glucose perfusion blocks counterregulation during systemic hypoglycemia in awake rats. J Clin Invest 1997; 99(2): 361–5

    Article  PubMed  CAS  Google Scholar 

  15. Borg WP, During MJ, Sherwin RS, et al. Ventromedial hypothalamus lesions in rats suppress counterregulatory hormone responses to hypoglycemia. J Clin Invest 1994; 93(4): 1677–82

    Article  PubMed  CAS  Google Scholar 

  16. Borg WP, Sherwin RS, During MJ, et al. Local ventromedial hypothalamus glycopenia triggers counterregulatory hormone release. Diabetes 1995; 44(2): 180–4

    Article  PubMed  CAS  Google Scholar 

  17. Cryer PE. Glucose counterregulation: prevention and correction of hypoglycemia in humans. Am J Physiol 1993; 264 (2 Pt 1): E149–55

    PubMed  CAS  Google Scholar 

  18. Rizza RA, Mandarino LJ, Gerich JE. Dose-response characteristics for the effects of insulin on production and utilization of glucose in man. Am J Physiol 1981; 240: E630–9

    PubMed  CAS  Google Scholar 

  19. Schwartz NS, Clutter WE, Shah SD, et al. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest 1987; 79: 777–81

    Article  PubMed  CAS  Google Scholar 

  20. Heller SR, Cryer PE. Hypoinsulinemia is not critical to glucose recovery from hypoglycemia in humans. Am J Physiol 1991; 261: E41–8

    PubMed  CAS  Google Scholar 

  21. Gerich J, Davis J, Lorenzi M, et al. Hormonal mechanisms of recovery from insulin induced hypoglycemia in man. Am J Physiol 1979; 236: E380–5

    PubMed  CAS  Google Scholar 

  22. Rizza R, Cryer PE, Gerich JE. Role of glucagon, epinephrine and growth hormone in human glucose counterregulation: effects of somatostatin and adrenergic blockade on plasma glucose recovery and glucose flux rates following insulin induced hypoglycemia. J Clin Invest 1979; 64: 62–71

    Article  PubMed  CAS  Google Scholar 

  23. Rizza RA, Cryer PE, Haymond MW, et al. Adrenergic mechanisms for the effect of epinephrine on glucose production and clearance in man. J Clin Invest 1980; 65: 682–9

    Article  PubMed  CAS  Google Scholar 

  24. Rizza RA, Cryer PE, Haymond MW, et al. Differential effects of physiological concentration of epinephrine on glucose production and disposal in man. Am J Physiol 1979; 237: E356–62

    PubMed  CAS  Google Scholar 

  25. White NH, Skor DA, Cryer PE, et al. Identification of type 1 diabetic patients at increased risk for hypoglycemia during intensive therapy. N Engl J Med 1983; 308: 485–91

    Article  PubMed  CAS  Google Scholar 

  26. Bolli GB, DeFeo P, DeCosmo S, et al. A reliable and reproducible test for adequate glucose counterregulation in type 1 diabetes mellitus. J Clin Invest 1985; 75: 1623–31

    Article  PubMed  CAS  Google Scholar 

  27. Caprio S, Gelfand RA, Tamborlane WV, et al. Oxidative fuel metabolism during mild hypoglycemia: critical role of free fatty acids. Am J Physiol Endocrinol Metab 1989; 256: E413–9

    CAS  Google Scholar 

  28. Fanelli CG, De Feo P, Porcellati F, et al. Adrenergic mechanisms contribute to the late phase of hypoglycemic glucose counterregulation in humans by stimulating lipolysis. Clin Invest 1992; 89(6): 2005–13

    Article  CAS  Google Scholar 

  29. Boyle PJ, Cryer PE. Growth hormone, Cortisol, or both are involved in defense against, but are not critical to recovery from, hypoglycemia. Am J Physiol 1991; 260: E395–402

    PubMed  CAS  Google Scholar 

  30. Mitrakou A, Ryan C, Veneman T, et al. Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol 1991; 260: E67–74

    PubMed  CAS  Google Scholar 

  31. Bolli GB, DeFeo P, Perriello G, et al. Role of hepatic autoregulation in defense against hypoglycemia in humans. J Clin Invest 1985; 75: 1623–31

    Article  PubMed  CAS  Google Scholar 

  32. Hansen I, Firth R, Haymond M, et al. The role of autoregulation of hepatic glucose production in man: response to a physiologic decrements in plasma glucose. Diabetes 1986; 35: 186–91

    Article  PubMed  CAS  Google Scholar 

  33. Campbell PJ, Bolli GB, Cryer PE, et al. Pathogenesis of the dawn phenomenon in patients with insulin-dependent diabetes mellitus: accelerated glucose production and impaired glucose utilization due to nocturnal surges in growth hormone secretion. N Engl J Med 1985; 312(23): 1473–9

    Article  PubMed  CAS  Google Scholar 

  34. Somogyi M. Insulin as a cause of extreme hyperglycemia and instability. Bull St Louis Med Soc 1938; 32: 498–501

    Google Scholar 

  35. Bolli GB, Gottesman IS, Campbell PJ, et al. Glucose counterregulation and waning of insulin in the Somogyi phenomenon (posthypoglycemic hyperglycemia). N Engl J Med 1984; 311(19): 1214–9

    Article  PubMed  CAS  Google Scholar 

  36. Kollind M. Studies on posthypoglycemic insulin resistance in insulin-dependent diabetes mellitus. Acta Med Scand Suppl 1988; 727: 1–56

    PubMed  CAS  Google Scholar 

  37. Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157: 1681–6

    Article  PubMed  CAS  Google Scholar 

  38. Zimmerman BR. Sulfonylureas. Endocrinol Metab Clin North Am 1997; 26: 511–22

    Article  PubMed  CAS  Google Scholar 

  39. Seltzer HS. Drug-induced hypoglycemia: a review of 1418 cases. Endocrinol Metab Clin North Am 1989; 18: 163–83

    PubMed  CAS  Google Scholar 

  40. Casparie AF, Elving LD. Severe hypoglycemia in diabetic patients: frequency, causes, prevention. Diabetes Care 1985; 8: 141–5

    Article  PubMed  CAS  Google Scholar 

  41. Fertig BJ, Simmons DA, Martin DB. Therapy for diabetes. In: Harris MI, Cowie CC, Stern MP, et al., editors. Diabetes in America. 2nd ed. Bethesda (MD): DHHS (NIH), 1995; Publication no. 95–1468: 519–40

    Google Scholar 

  42. Gerich JE. Oral hypoglycemic agents. N Engl J Med 1989; 321: 1231–41

    Article  PubMed  CAS  Google Scholar 

  43. Wiholm BE, Westerholm B. Drug utilization and morbidity statistics for the evaluation of drug safety in Sweden. Acta Med Scand Suppl 1984; 683: 107–17

    PubMed  CAS  Google Scholar 

  44. Berger W. Incidence of severe side effects during therapy with sulfonylureas and biguanides. Hormone Metab Res 1985; 17Suppl. 15: 111–5

    Google Scholar 

  45. Campbell IW. Metformin and the sulfonylureas: the comparative risk. Horm Metab Res 1985; 17Suppl. 15: 105–11

    Google Scholar 

  46. Van Staa T, Abenhaim L, Monette J. Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997; 50: 735–41

    Article  PubMed  Google Scholar 

  47. Shorr RI, Ray WA, Daugherty JR, et al. Individual sulfonylureas and serious hypoglycemia in older people. J Am Geriatr Soc 1996; 44: 751–5

    PubMed  CAS  Google Scholar 

  48. Stahl M, Berger W. Higher incidence of severe hypoglycemia leading to hospital admission in type 2 diabetic patients treated with long-acting versus short-acting sulfonylureas. Diabet Med 1999; 16: 586–90

    Article  PubMed  CAS  Google Scholar 

  49. Jennings AM, Wilson RM, Ward JD. Symptomatic hypoglycaemia in NIDDM patients treated with oral hypoglycaemic agents. Diabetes Care 1989; 12: 203–8

    Article  PubMed  CAS  Google Scholar 

  50. Burge MR, Schmitz-Fiorentino K, Fischette C, et al. A prospective trial of risk factors for sulfonylurea-induced hypoglycemia in type 2 diabetes mellitus. JAMA 1998; 279: 137–43

    Article  PubMed  CAS  Google Scholar 

  51. Walter MW. Hypoglycemia: still a risk in the elderly. Geriatrics 1990; 45: 69–75

    PubMed  Google Scholar 

  52. Brodows RG. Benefits and risks with glyburide and glipizide in elderly NIDDM patients. Diabetes Care 1992; 15: 75–80

    Article  PubMed  CAS  Google Scholar 

  53. Heinsmer JA, Lefowitz RJ. The impact of aging and adrenergic receptor function: clinical and biochemical aspects. J Am Geriatr Soc 1985; 33: 184–8

    Google Scholar 

  54. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type a diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998; 317: 713–20

  55. Shorr RI, Wayne AR, Daugherty JR, et al. Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278: 40–3

    Article  PubMed  CAS  Google Scholar 

  56. Herings RM, de Boer A, Stricker BH, et al. Hypoglycemia associated with use of inhibitors of angiotensin-converting enzymes. Lancet 1995; 345: 1195–8

    Article  PubMed  CAS  Google Scholar 

  57. Rasmussen BM, Orskov L, Schmitz O, et al. Alcohol and glucose counterregulation during acute insulin induced hypoglycemia in type 2 diabetes subjects. Metabolism 2001; 50: 451–7

    Article  PubMed  CAS  Google Scholar 

  58. Burge MR, Zeise TM, Sobhy TA, et al. Low dose ethanol predisposes elderly fasted patients with type 2 diabetes to sulfonylurea-induced low blood glucose. Diabetes Care 1999; 22: 2037–43

    Article  PubMed  CAS  Google Scholar 

  59. Sood V, Sobhy TA, Schade DS, et al. Low dose ethanol delays recovery from hypoglycemia in type 2 diabetes [abstract]. Diabetes 2000; 49Suppl. 1: A66

    Google Scholar 

  60. Sood V, Sobhy T, Schade DS, et al. Low dose ethanol alters epinephrine responses and decreases glucose production during hypoglycemia in patients with type 2 diabetes [abstract]. Diabetes 2001; 50Suppl. 1: A139

    Google Scholar 

  61. Riddle MC, McDaniel PA, Tive LA. Glipizide GITS does not increase the hypoglycemic effect of mild exercise during fasting in NIDDM. Diabetes Care 1997; 20: 992–4

    Article  PubMed  CAS  Google Scholar 

  62. Katz MS, Lowenthal DT. Influences of age and exercise on glucose metabolism: implications for management of older diabetics. South Med J 1994; 87: S70–3

    PubMed  CAS  Google Scholar 

  63. Gerich JE, Langlois M, Noacco C, et al. Lack of glucagons response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha cell defect. Science 1973; 182: 171–3

    Article  PubMed  CAS  Google Scholar 

  64. Fukuda M, Tanaka A, Tahara Y, et al. Correlation between minimal secretory capacity of pancreatic beta-cells and stability of diabetic control. Diabetes 1988; 37: 81–8

    Article  PubMed  CAS  Google Scholar 

  65. Robertson RP, Porte Jr D. The glucose receptor: a defective mechanism in diabetes mellitus distinct from the beta-adrenergic receptor. J Clin Invest 1973; 52: 870–6

    Article  PubMed  CAS  Google Scholar 

  66. Meneilly GS, Cheung E, Tuokko H. Altered response to hypoglycemia of healthy elderly people. J Clin Endocrinol Metab 1994; 78: 1341–8

    Article  PubMed  CAS  Google Scholar 

  67. Marker JC, Cryer PE, Clutter WE. Attenuated glucose recovery from hypoglycemia in the elderly. Diabetes 1992; 41: 671–8

    Article  PubMed  CAS  Google Scholar 

  68. Meneilly GS, Cheung E, Tuokko H. Counterregulatory hormone responses to hypoglycemia in the elderly patient with diabetes. Diabetes 1994; 43: 403–10

    Article  PubMed  CAS  Google Scholar 

  69. Segel SA, Deanna SP, Paramore S, et al. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Diabetes 2002; 51: 724–33

    Article  PubMed  CAS  Google Scholar 

  70. Korzon-Burakowska A, Hopkins D, Matyka K, et al. Effects of glycemic control on protective responses against hypoglycemia in type 2 diabetes. Diabetes Care 1998; 21: 283–90

    Article  PubMed  CAS  Google Scholar 

  71. Burge MR, Sobhy TA, Quails CR, et al. Effect of short-term glucose control on glycemic thresholds for epinephrine and hypoglycemic symptoms. J Clin Endocrinol Metab 2001; 86: 5471–8

    Article  PubMed  CAS  Google Scholar 

  72. Mokan M, Mitrakou A, Veneman T, et al. Hypoglycemia unawareness in IDDM. Diabetes Care 1994; 17: 1397–403

    Article  PubMed  CAS  Google Scholar 

  73. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 1994; 17: 697–703

    Article  PubMed  CAS  Google Scholar 

  74. Veneman T, Mitrakou A, Mokan M, et al. Induction of hypoglycemia unawareness by symptomatic nocturnal hypoglycemia. Diabetes 1993; 42: 1233–7

    Article  PubMed  CAS  Google Scholar 

  75. Thomson FJ, Masson EA, Leeming JT, et al. Lack of knowledge of symptoms of hypoglycemia by elderly diabetic patients. Age Ageing 1991; 20: 404–6

    Article  PubMed  CAS  Google Scholar 

  76. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes mellitus. JAMA 2002; 288: 475–82

    Article  PubMed  Google Scholar 

  77. Colleran KM, Starr B, Burge MR. Putting diabetes to the test: analyzing glycemic control based on patients’ diabetes knowledge. Diabetes Care 2003; 26: 2220–1

    Article  PubMed  Google Scholar 

  78. Rabasa-Lhoret R, Bourque J, Ducros F, et al. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 2001; 24(4): 625–30

    Article  PubMed  CAS  Google Scholar 

  79. Rosenstock J, Shen GS, Gatlin MR, et al. Combination therapy with nateglinide and a thiazolidinedione improves glycemic control in type 2 diabetes. Diabetes Care 2002; 25: 1529–33

    Article  PubMed  CAS  Google Scholar 

  80. Saloranta C, Kenneth H, Ball M, et al. Efficacy and safety of nateglinide in type 2 diabetic patients with modest fasting hyperglycemia. J Clin Endocrinol Metab 2002; 87: 4171–6

    Article  PubMed  CAS  Google Scholar 

  81. Frische A, Schweitzer MA, Häring HU, et al. Glimepiride combined with morning insulin glargine, bedtime neutral protamine hagedorn insulin, or bedtime insulin glargine in patients with type 2 diabetes. Ann Intern Med 2003; 138: 952–9

    Google Scholar 

  82. Yki-Jarvinen H, Dressier A, Ziemen M, et al. Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. Diabetes Care 2000; 23: 1130–6

    Article  PubMed  CAS  Google Scholar 

  83. Cooper WC. Fatal asymptomatic hypoglycemia in an elderly insulin-dependent diabetic patient taking an oral beta-blocking medication. Diabetes Care 1998; 21: 2197–8

    Article  PubMed  CAS  Google Scholar 

  84. Fischer KF, Lees JA, Newman JH. Hypoglycemia in hospitalized patients. N Engl J Med 1986; 315: 1245–50

    Article  PubMed  CAS  Google Scholar 

  85. Benbow SJ, Walsh A, Gill GV. Diabetes in the institutionalized elderly: a forgotten population? BMJ 1997; 315: 1868–70

    Article  Google Scholar 

  86. Tattersall R, Simon P. Managing diabetes in residential and nursing homes: presents a complex set of problems with no one solution. BMJ 1998; 316: 89

    Article  PubMed  CAS  Google Scholar 

  87. Effects of intensive diabetes therapy on neuropsychological function in adults in the diabetes control and complications trial. Ann Intern Med 1996; 124: 379–88

  88. Pramming S, Thorsteinsson B, Theilgaard A, et al. Cognitive function during hypoglycaemia in type I diabetes mellitus. BMJ 1986; 292: 647–50

    Article  PubMed  CAS  Google Scholar 

  89. Fontbonne A, Berr C, Ducimetiere P. Poorer cognitive performance evolution over four years in elderly diabetics compared to controls with normal or impaired fasting blood glucose. Diabetes 2000; 49Suppl. 1: A191–2

    Google Scholar 

  90. Davis SN, Shavers C, Davis B, et al. Prevention of an increase in plasma cortisol during hypoglycemia preserves subsequent counterregulatory responses. J Clin Invest 1997; 100: 429–38

    Article  PubMed  CAS  Google Scholar 

  91. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes 1994; 43: 1426–34

    Article  PubMed  CAS  Google Scholar 

  92. Cranston I, Lomas J, Maran A, et al. Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Lancet 1994; 344: 283–7

    Article  PubMed  CAS  Google Scholar 

  93. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-term results of the Kumamoto study on optimal diabetes control in type 2 diabetic patients. Diabetes Care 2000; 23Suppl. 2: B21–9

    PubMed  Google Scholar 

  94. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes: technical review. Diabetes Care 2003; 26: 1902–12

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Medicine/Endocrinology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA

    Aruna Chelliah &  Mark R. Burge

Authors
  1. Aruna Chelliah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark R. Burge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark R. Burge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chelliah, A., Burge, M.R. Hypoglycaemia in Elderly Patients with Diabetes Mellitus. Drugs Aging 21, 511–530 (2004). https://doi.org/10.2165/00002512-200421080-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200421080-00003

Keywords

Search

Navigation