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MEDICAL NEWS | PHYSICIAN'S FIRST WATCH
Diabetes Frequently Overtreated in Older Adults
老年或是體虛的糖尿病患者，不要把血糖控制得太好，這是早已知道的事，而然最近就發生在一位出院洗腎病人身上。在住了5個多月後，總算能出院了，當然身體瘦弱，住院即用insulin治療高血糖。
一次洗腎後到家，說昏迷（我們最擔心這樣的事...），原來是低血糖，說是等交通車太久，加上洗腎少灌一次牛奶，早上來洗腎時，家屬也是照打insulin的結果。因為這一次的經驗，家屬要求收針前測血糖，低的話，要注射葡萄糖，當然我們就教導家屬要減少注意insulin。
結果一次，來洗腎時低血糖（家屬當天早上也有打insulin)，收針補了葡萄糖，到家後說10分鐘後昏迷，就走了...
然而，年輕, 健康的DM患者，得確是值得嚴格控制血糖，hemoglobin A1c levels below 6.5%–7%。
Using 2001–2010 NHANES data, researchers studied a nationally representative sample of 1300 diabetics aged 65 or older. Approximately 50% were considered relatively healthy, 28% were in complex health, and 21% were in poor health. In each health category, roughly 60% of patients had an HbA1c measurement below 7%; of these, over half received treatments that can lead to severe hypoglycemia (insulin or sulfonylureas).
The authors point to the many poor outcomes with hypoglycemia, including death, heart disease, falls, and dementia. "Therefore," they conclude, "intensive strategies to lower glucose levels may result in more harm than benefit, especially among older, sicker patients."
