Hypos in an older person with diabetes: the signs and what to do

The tablets are the place to start. If your relative has type 2 diabetes and takes only metformin, or manages it with diet alone, NICE does not count their treatment among those linked with hypos. If they take insulin, or a tablet from the group called sulfonylureas, such as gliclazide, the risk is there every day, and the rest of this page applies in full. Alcohol, more activity than usual, being unwell and a poor appetite then add to it. Insulin at home explains who gives insulin and how it is managed day to day.

Each of these has other explanations, which is why a hypo can be missed. Diabetes UK says that when somebody with dementia becomes suddenly confused or their behaviour changes, a hypo should be checked for, and that if you are unsure, you check their blood sugar. That advice serves any family. If your relative takes insulin or gliclazide and has suddenly become muddled, unsteady or unlike themselves, treat a hypo as one possibility rather than putting it down to age, a bad night or their memory.

After a fall, mention diabetes to whoever comes to help, and tell the GP so the medicines can be looked at as a possible cause. Mobility and falls care covers what to do after a fall and how to make the house safer.

Speed matters most. What is needed first is sugar that works quickly, and the NHS puts biscuits and sandwiches in the second step, as the longer-lasting food that follows. Diet drinks contain no sugar and do nothing for a hypo. Diabetes UK puts the amount at 15 to 20 grams of fast-acting carbohydrate, and its examples include 150 to 200ml of a regular fizzy drink or 200ml of pure fruit juice.

The one rule that does not bend is the one about swallowing. Diabetes UK and the NHS both say to give nothing by mouth to somebody who is unconscious, because they cannot swallow it safely. Glucagon is an injection kept by some people who take insulin, and it is used only by somebody who has been shown how. If there is none in the house, or nobody knows how to use it, ring 999 and stay with them.

Keep the hypo treatment in the same places so whoever is with them can find it. The written plan from their GP or diabetes team should say what treatment they use, and a diabetes care plan for home shows how to put that plan, the hypo steps and the phone numbers on one page a carer or relative can follow.

The point of telling the GP is that the medicines can change. A dose or a tablet that suited your relative five years ago may now be too strong if they eat less, or have developed kidney problems or another illness. Diabetes UK says target levels may need to be higher in older people, and NICE asks doctors to consider relaxing the target for people who are older or frailer if tight control would put them at high risk from a hypo. The decision belongs to the GP or diabetes team, with your relative. Nobody in the family, and no carer, stops, starts or changes a diabetes medicine because of a hypo. Ask too about a glucose sensor worn on the arm: NICE recommends one for some people on insulin who have repeated or severe hypos, or who would otherwise need a care worker to check their blood sugar.

If the nights are when things go wrong, somebody sleeping in the house can make a difference. On PrimeCarers a sleeping night costs £160 to £190 with our fee included, and a waking night, where the carer stays up, £165 to £250. Overnight care explains the difference between the two and when each one suits.

The food question is about timing and regularity rather than a special diet. Diabetes UK says regular mealtimes and snacks containing carbohydrate help prevent hypos in older people, and that a smaller appetite or irregular eating can cause them. For somebody who is eating less than they used to, that is worth raising with the GP, because a dose set when they ate three full meals a day may be too much now. Eating well with diabetes in later life covers meals, snacks and a poor appetite.

On alcohol, the NHS advice for people on diabetes medicines is not to drink without eating, and to keep within 14 units a week, spread over three days or more. Being unwell is its own risk, because somebody who is ill may eat little while their medicine stays the same. Ask the GP or pharmacist for written sick day rules before they are needed, so nobody is guessing on the day.

1. 1

   Write down the hypo plan

   Before the first visit

   What a hypo looks like for your relative, what treatment they use and where it is kept, whether there is glucagon and who has been trained to use it, and who to ring. Put it where a carer will see it.
2. 2

   Agree meals and tablets around the risky times

   At the first visit

   A carer can cook and sit with your relative at mealtimes, prompt tablets at the time on the label, and write down what was eaten and taken. That record is useful to the GP after a hypo.
3. 3

   Recognise the change, and treat by the plan

   On every visit

   Somebody who sees your relative regularly can notice when they are muddled or unsteady. A carer can give a sugary drink and something to eat as the plan says, and ring 999 if they cannot swallow safely.
4. 4

   Tell the family and the GP

   The same day

   A carer can ring you, help your relative call the GP or diabetes team, and tell paramedics what they saw and what was given.

Insulin is not part of an ordinary visit. An injection, a blood sugar test done as a clinical task, and glucagon are delegated health tasks: they pass to a carer only where a healthcare professional, usually the district nurse, has trained that named carer and agreed it in writing. Otherwise they stay with your relative, the family or the nurse. Prompting somebody who injects their own insulin is different, and is part of ordinary care. Can a private carer give medication explains where the line sits.

If you want somebody with your relative at mealtimes, or in the mornings when tablets are taken, you can search for carers near you and compare their rates. There is no way to search for carers by diabetes experience. What a carer says about it is their own account on their profile, so ask them about hypos when you meet and check what matters to you. PrimeCarers is an introductory service: you choose the carer, meet them first and agree the hours and the routine with them directly. Every carer has had their identity and right to work checked, holds an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 2 years, and has been interviewed online. Carers are insured while they work. We do not check qualifications or training.