14
Standards of Medical Care
Hypoglycemia
Î Individuals at risk for hypoglycemia should be asked about
symptomatic and asymptomatic hypoglycemia at each encounter. (C)
Î Glucose (15-20 g) is the preferred treatment for the conscious
individual with hypoglycemia, although any form of carbohydrate that
contains glucose may be used. If SMBG 15 min after treatment shows
continued hypoglycemia, the treatment should be repeated. Once
SMBG returns to normal, the individual should consume a meal or
snack to prevent recurrence of hypoglycemia. (E)
Î Prescribe glucagon for all individuals at significant risk of severe
hypoglycemia, and instruct caregivers or family members of these
individuals in its administration. Glucagon administration is not
limited to health care professionals. (E)
Î Hypoglycemia unawareness or one or more episodes of severe
hypoglycemia should trigger re-evaluation of the treatment regimen. (E)
Î Advise individuals with hypoglycemia unawareness or one or more
episodes of severe hypoglycemia to raise their glycemic targets to
strictly avoid further hypoglycemia for at least several weeks. (A)
Note: This partially reverses hypoglycemia unawareness and reduces the risk of
future episodes.
Î Ongoing assessment of cognitive function is suggested with increased
vigilance for hypoglycemia by the clinician, patient, and caregivers if
low cognition and/or declining cognition is found. (B)
Bariatric Surgery
Î Consider bariatric surgery for adults with BMI >35 kg/m
2
and type 2
diabetes, especially if the diabetes or associated comorbidities are
difficult to control with lifestyle and pharmacologic therapy. (B)
Î Patients with type 2 diabetes who have undergone bariatric surgery
need lifelong lifestyle support and medical monitoring. (B)
Î Although small trials have shown glycemic benefit of bariatric surgery
in patients with type 2 diabetes and BMI of 30-35 kg/m
2
, there is
currently insufficient evidence to generally recommend surgery in
patients with BMI <35 kg/m
2
outside of a research protocol. (E)
Î The long-term benefits, cost-effectiveness, and risks of bariatric
surgery in individuals with type 2 diabetes should be studied in well-
designed controlled trials with optimal medical and lifestyle therapy
as the comparator. (E)
