ABSTRACT
This chapter reviews the problem of hypoglycemia among elderly individuals. It considers diabetes self-care and hypoglycemia prevention and management strategies. The brain transports roughly three times more glucose from the circulation across the blood–brain barrier than is needed to satisfy the normal metabolism. When a critical glucose threshold is reached, centers in the hypothalamus sense the fall in systemic glucose concentrations and stimulate the release of glucagon and epinephrine. The exact relationship between a fall in the plasma glucose concentration and the activation of counterregulatory hormones, the initiation of warning symptoms, or the onset of deterioration in cerebral function is complex. Glucose autoregulation is independent of counterregulatory hormones and is observed only during conditions of severe hypoglycemia. Self-monitoring of blood glucose (SMBG) is an integral part of diabetes self-management programs. SMBG is utilized to determine patterns and maintain glucose levels for short- and long-term–assessment glycemic control.
