Risk factors based on diabetes type1–4

Type 1 diabetes
History of severe episodes
HbA1c <6.5% (except in youth)
High glucose variability (in older adults)
Renal impairment
Impaired awareness of hypoglycaemia
Advanced age, very young age

Type 2 diabetes (on insulin or sulfonylureas)
Cognitive impairment
Depression
Aggressive glycaemia treatment
Impaired awareness of hypoglycaemia
Duration of insulin therapy
Renal impairment and other comorbidities
Advanced age

Factors that may increase risk of nocturnal hypoglycaemia5,6

  • Stress
  • Diabetic neuropathy
  • Physical exercise, especially during the evening
  • Excess insulin during the day
  • Previous episodes of nocturnal hypoglycaemia
  • High dose of basal insulin
  • Failure to check blood glucose at bedtime
  • Excess rapid-acting insulin to correct high glucose, particularly at bedtime, or to cover bedtime snacks
  • Physical exercise, especially during the evening
  • Premix or short-acting insulin before dinner
  • NPH insulin (isophane) in the evening

Key needs to mitigate risks

Key needs to mitigate hypoglycaemia risks

References

  • 1
    Yale JF et al. Hypoglycaemia.
    In: Diabetes Canada Full Guidelines.
    2018. Available at:
    https://guidelines.diabetes.ca/cpg
    /chapter14.
  • 2
    International Hypoglycaemia Study Group. Minimizing hypoglycaemia in diabetes. Diabetes Care 2015;38:1583.
  • 3
    Inzucchi SE et al. Management of hyperglycemia in Type 2 diabetes, 2015: A patient-centered approach. Diabetes Care 2015;38:
  • 4
    Weinstock RS et al. Risk factors associated with severe hypoglycemia in older adults with Type 1 diabetes. Diabetes Care 2016 Apr;39:603.
  • 5
    Vu L et al. Predicting Nocturnal Hypoglycaemia from Continuous Glucose Monitoring Data with Extended Prediction Horizon. AMIA Annu Symp Proc. 2019;874-882
  • 6
    Brunton SA. Nocturnal hypoglycemia: Answering the challenge with long-acting insulin analogs. MedGenMed 2007;9:38.
  • 1
    Yale JF et al. Hypoglycaemia. In: Diabetes Canada Full Guidelines. 2018. Available at: https://guidelines.diabetes.ca/cpg/chapter14.
  • 2
    International Hypoglycaemia Study Group. Minimizing hypoglycaemia in diabetes. Diabetes Care 2015;38:1583.
  • 3
    Inzucchi SE et al. Management of hyperglycemia in Type 2 diabetes, 2015: A patient-centered approach. Diabetes Care 2015;38:
  • 4
    Weinstock RS et al. Risk factors associated with severe hypoglycemia in older adults with Type 1 diabetes. Diabetes Care 2016 Apr;39:603.
  • 5
    Vu L et al. Predicting Nocturnal Hypoglycaemia from Continuous Glucose Monitoring Data with Extended Prediction Horizon. AMIA Annu Symp Proc. 2019;874-882
  • 6
    Brunton SA. Nocturnal hypoglycemia: Answering the challenge with long-acting insulin analogs. MedGenMed 2007;9:38.