Trong một nghiên cứu hồi cứu (Reenders 1992) trong một nhóm thực hành, 93 bệnh nhân tiểu đường đã được nghiên cứu trong giai đoạn 1975 ± 85 (483 bệnh nhân tiểu đường-năm). Trong số 26 tập hạ đường huyết trình bày cho bác sĩ gia đình, đã ® được giới thiệu đến bệnh viện. | APPROACHING make them feel better and avoid hypoglycaemia Tattersail 1984 also see Chapter 12 . Acute Complications Hypoglycemia hyperglycemic coma and intercurrent infection are examples of acute complications presented first to the GP. A selection of these patients the tip of the iceberg often present to the hospital. But what is under the iceberg In a retrospective study Reenders 1992 in a group practice 93 diabetic patients were studied in the period 1975-85 483 dia-betic-years . Of the 26 hypoglycemic episodes presented to the GP five were referred to the hospital. In the same period two patients were referred with hyperglycemic coma and of the 176 infections presented to the practice three patients were admitted to the hospital. Especially in elderly patients hypoglycemia is a serious side-effect of treatment with insulin or long-acting sulfonylurea tablets. Hypoglycemia is mostly a consequence of too intensive treatment and or too little compliance by the patient. Hypoglycemia in the elderly could have serious consequences a car accident a fall resulting in a fracture insult TIA or stroke. Sometimes more non-specific symptoms Knight and Kesson 1986 are presented and are often attributed by patient and doctor to age seizure drowsy or contused. It is important to reduce these risks by avoiding sulfonylureas with a long half-life and accepting a sub-optimal level of blood glucose. Quality of life is important in the elderly and after a serious hypoglycemic episode they fear a new episode. It is the task of the primary care team to educate the patients to prevent hypoglycemia. But education in the elderly is difficult. DATA FROM THE AUTHOR S PRACTICE In the author s group practice we have reviewed diabetes care on an annual basis. At the millennium the practice consisted of6300 patients of whom 18 were aged over 65 years and of them were known to have diabetes. Of the over-65s 83 were under the care of a GP Table . Nineteen patients were housebound and
