Hypoglycemia in the Elderly: Clinical Recognition, Risks, and Management Strategies

Abstract

Hypoglycemia is a frequent yet underrecognized clinical condition among elderly individuals, particularly those living with diabetes mellitus, and represents a major challenge to achieving safe and effective glycemic control in this vulnerable population. Advancing age is associated with progressive physiological changes that impair glucose homeostasis, including reduced renal drug clearance, diminished hepatic glucose production, blunted autonomic warning responses, and altered counterregulatory hormone secretion. When combined with multiple comorbidities, polypharmacy, cognitive decline, nutritional inadequacy, and irregular dietary intake, these age-related alterations substantially increase susceptibility to hypoglycemic episodes. Despite its high prevalence, hypoglycemia in older adults is often overlooked because symptoms are frequently atypical, nonspecific, or subtle, manifesting as confusion, dizziness, weakness, visual disturbances, or behavioral changes that may be mistakenly attributed to normal aging or underlying neurological disorders.In conclusion, hypoglycemia in the elderly is a multifactorial and clinically significant condition with serious short- and long-term consequences. Improved awareness, early recognition, individualized glycemic strategies, judicious pharmacotherapy, and multidisciplinary care are essential to reducing hypoglycemia-related morbidity and mortality. Proactive prevention and patient-centered management are crucial to preserving functional independence, enhancing quality of life, and optimizing diabetes care outcomes in elderly populations. Future research should focus on developing geriatric-specific risk assessment tools, integrating continuous glucose monitoring in routine elderly care, and strengthening interdisciplinary collaboration among physicians, pharmacists, nurses, and caregivers. Such strategies may facilitate early detection, timely intervention, and sustainable glycemic management while addressing the unique physiological, social, and economic challenges faced by older adults with diabetes globally across diverse healthcare systems and resource-limited settings worldwide.