Why is hypoglycaemia particularly dangerous in older persons with diabetes?

Hypoglycaemia is especially dangerous in older persons because age-related blunting of adrenergic warning signs means blood glucose can drop much lower before symptoms appear. Also, neuroglycopenic symptoms like confusion and sleepiness may be mistaken for cognitive impairment, and frailty increases the risk of falls and injury from a hypo.

In older people, physiological counter-regulatory responses such as tremor, sweating, and palpitations are blunted, so they may not experience early warning symptoms until glucose levels have fallen dangerously low. When neuroglycopenic symptoms such as confusion, drowsiness, or unusual behaviour do occur, these can be misinterpreted as dementia or another cognitive disorder, delaying recognition and treatment. Moreover, older and frail individuals are more vulnerable to the physical consequences of a hypo, particularly falls and subsequent injuries, which can lead to further loss of independence and serious complications.