That is not what you said the first time. You didn't say anything about medication, just "non-insulin dependent" and that was the part I disagreed with.
OK, I just don't want to get into another internet argument over hypoglycemia or what each of us said, like what happened with salim a while ago...
But, I *DID* mention medication
(and so I do feel justified in explaining myself)... Exactly what I said WAS:
The risk of a non-insulin dependent diabetic going into hypoglycemia is very rare. However there are some glucose-lowering medications (some aren't even diabetes related) and some people who don't quite fit the norms, so it does (though rarely) happen.
So yes, I did mention more than just insulin-dependence - mentioning medications specifically. I felt my statement should have implied, and I hoped people would infer, that what I mean was exclusive of those not on another glucose-lowering medication. However, you cannot always clearly state all your intentions and beliefs in one post.
As for hypoglycemia being "rare" among T2's ... I guess this depends on your definition of "rare".
(Although clinically, it's certainly RARE, which I'll go on to show in just a moment if you continue patiently reading.)
To me,
even though I can get hypoglycemic, it's rare. Usually I hit around a 4.0 - 4.5 mmol/l (about 72 - 81) and my liver releases more glucose. However, there are times it just keeps going down, especially if I don't eat at minimum of every 3-4 hours and I've been exercising a lot in addition to my low-carb diet. So it's not
always happening to me, and I'm one of the T2's that is on a particular medication
(not even diabetes-related) that makes it so I CAN experience it. If I eat properly, it will be a rare occurrence.
The research you link to just further proves my point. The first is specific to only certain segments of the T2 population - those "with limited health literacy". As such, it's a small segment of the T2 population - indicating the event is not commonplace among all T2's.
The second article clearly states...
"In type 2 diabetes, severe hypoglycemia appears to be much less common, but when patients with type 2 diabetes receive insulin they may become as susceptible to hypoglycemia as patients with type 1 diabetes."
...further proving my point. Also, the fact that they call it a
"major clinical problem" doesn't make it "common" in type 2's, just perhaps common in a clinical setting
(IE: doctors offices, emergency rooms, etc.).
The third article states:
"One of the most common causes of hypoglycemia is injecting too much insulin. People with diabetes who inject insulin are at high risk of developing hypoglycemia. But anyone with diabetes using hypoglycemic (blood sugar lowering) medications needs to watch for signs of hypoglycemia."
... again, proving my point. Also, nowhere on this article does it state hypoglycemia is a common condition among T2 diabetics.
Now here's
why I state it's rare...
From
this article:
"Results: We studied 1055 patients. Prevalence of hypoglycemic symptoms was 12% (9/76) for patients treated with diet alone, 16% (56/346) for those using oral agents alone, and 30% (193/633) for those using any insulin (P,.001). Severe hypoglycemia occurred in only 5 patients (0.5%), all using insulin."
*Note, this is a cut/paste from the full article, not from the abstract linked to above. I actually go crazy and purchase full articles to read...
Less than 1/2 of one percent of Type 2's in their survey experienced severe hypoglycemia - thus making it extremely rare.
... many people confuse hypoglycemic SYMPTOMS with hypoglycemia
(a severe, dangerous medical condition), and they are not the same thing. Even if you choose to use the data for those that only experienced symptoms
(12% and 16% for the two non-insulin groups), we're still looking at it NOT being a commonplace occurrence.
That report concluded with:
"Mild hypoglycemia is common in patients with type 2 diabetes undergoing aggressive diabetes management, but severe hypoglycemia is rare. "
Aggressive Diabetes Management, according to both the IDF (International Diabetes Federation) and the AACE (American Association of Clinical Endocrinologists) is generally described as much lower targets than the current recommendations, and includes (especially in studies) multiple glucose-lowering agents as well as insulin therapy.
(Somebody needs to tell them to try lowering carbohydrate first ....)
Another study (published by the AACE) on hypoglycemia in NIDDM
(Non-Insulin-Dependent Diabetes Mellitus) goes on to say:
"Results: Of the 262 study participants interviewed, 172 insulin-using and 90 sulfonylurea-using patients were asked whether they had ever had hypoglycemia severe enough to require the assistance of another person. Of the 90 sulfonylurea-treated patients with NIDDM, 3 (3.3%) reported experiencing severe hypoglycemia on one occasion only. Of the 172 insulin-utilizing patients, 13 (7.6%) had had severe hypoglycemic episodes"
And those ARE for those on both Insulin-therapy AND sulfonylureas. Those numbers are not what we'd call "common". The risk of severe hypoglycemia is still rare.
They also concluded:
"On the basis of this study, we conclude that severe hypoglycemia is extremely uncommon in NIDDM. When it occurs, it is usually accidental and seldom recurs. Patients with multiple bouts of severe hypoglycemia have almost complete insulin deficiency. Thus, aggressive treatment of NIDDM to avoid diabetic complications is rarely associated with severe hypoglycemia and is usually well tolerated."
Like I said, I don't really want to get into an argument here. I've spent a lot of time researching this disease, and I can provide article after article to back me up, whereas it's my opinion that what you've provided doesn't back up your statements.
You are entitled to your belief, but even if a primary side-effect of sulfonylureas is hypoglycemia, it doesn't change the fact that all the research and evidence states that severe hypoglycemia in a Type 2 is rare. EVEN if they're on sulfonylureas or any other glucose-lowering agent.
Edit: Also, when you state...
So "Severe Hypoglycemia" might be less common amount type 2s than type 1s, but mild to moderate hypoglycemia is more common and given the much larger numbers of type 2s it appears that the total number of type 2s that suffer from mild to sever hypoglycemia is actually higher than type 1s.
Just because there are more Type 2's than Type 1's, it doesn't make it common among the Type 2's. Hypoglycemia, even mild symptoms, is still
rare, unless you consider 12% and 16% occurrence to be commonplace.
Another EDIT: And with that, I believe we've most certainly hijacked this thread on A1c targets enough, oops. I suggest if we want to continue a respectful debate, we do it in our own thread, if that's ok.