Causes

Two landmark trials, The Diabetes Control & Complications Trial (DCCT) [4] and the UK Prospective Diabetes Study [8], reported increased incidence of hypoglycaemia with intensive therapy. HbA1c levels within the normal range are associated with increased risk of hypoglycaemia.

Type 1 diabetics

In type 1 diabetics, insulin errors, missed meals and excessive exercise were important causes of hypoglycaemia [9].

Type 2 diabetics

In type 2 diabetics, advanced age and inadequate energy intake are the main risk factors for those patients on sulphonylureas [10].

Elderly patients

In elderly patients, the main risk factors for severe hypoglycaemia are:

• Advanced age
• Recent hospitalisation/intercurrent illness
• Polypharmacy [7]