Skip to content

Perspectives on Diabetes Care

This is the official blog of the Association of Diabetes Care & Education Specialists where we share recent research and professional opinions on diabetes care and education.


Explore Helpful Views on Diabetes Care & Education

If you're looking for professional opinions on diabetes care and education, you're in the right place. Perspectives on Diabetes Care is the official ADCES® diabetes care and education blog that shares helpful views on diabetes care and education. 

This is where you'll find practical tips on working with people affected by prediabetes, diabetes and related cardiometabolic conditions and the latest research and viewpoints on issues facing diabetes care and education specialists and the people they serve.



Current & Past ADCES Blog Articles


Severe Hypoglycemia: Are Your At-Risk Patients Prepared?

Jan 24, 2023, 15:58 PM

By Academy for Continued Healthcare Learning (ACHL), with Davida F. Kruger, MSN, APN-BC, BC-ADM and Anne Peters, MD.

This post is sponsored by the ACHL, an independently owned and operated full-service medical education company that has been developing certified health care education for nearly twenty years. This activity is supported by an educational grant from Lilly. This activity was sponsored by Purdue University College of Pharmacy, in partnership with ACHL.


Despite advances in care, hypoglycemia remains a common complication. New therapies have less risk and patients increasingly use continuous glucose monitoring, but episodes still occur. Some of these episodes are severe and patients require assistance for recovery.

Davida F. Kruger, MSN, APN-BC, BC-ADM explains, “hypoglycemia and the fear of hypoglycemia continues to be a common complication of diabetes that requires the health care provider discuss the prevention and treatment at each visit. An assessment of any events that may have occurred should also be evaluated.”

Hypoglycemia negatively impacts patient quality of life, and is associated with higher healthcare utilization, poorer glycemic control, and medication nonadherence. Severe episodes can increase the risk of all-cause mortality and cardiovascular morbidity and mortality. Severe hypoglycemia is a serious complication and a medical emergency.

Patients’ occurrence and risk of hypoglycemia should be assessed at every encounter. Those with an increased risk of level 2 or 3 hypoglycemia should have an active prescription for glucagon. Unfortunately, glucagon remains underutilized and under prescribed, and few patients fill their prescription for emergency glucagon. Anne Peters, MD shares that, “all patients on insulin should be counseled to obtain and fill a prescription for a second-generation glucagon formulation. The patient should work with friends and family who surround them to be sure they know how and when to use the glucagon.”

There are second generation glucagon formulations that can help patients and their caregiver choose the best approach. The patient and their family, friends, and coworkers should all know where their emergency glucagon is and how to use it.

To better support healthcare providers, Davida F. Kruger, and Anne Peters, in collaboration with the ACHL, developed a simple, systematic approach to quality improvement to ensure that patients are prepared to prevent, recognize, and manage hypoglycemia, which can be accessed here. The framework and tools are intended for easy access and application at any practice setting.

The quality improvement activity includes interventions and tools to assist you in practice, including:

  • Presentations by Ms. Kruger and Dr. Peters covering the latest evidence and guidance.
  • Case discussion featuring patients at high risk of severe hypoglycemia.
  • Digital clinical tool to help you assess a patient’s risk and ensure they are prepared.
  • Downloadable handout on developing alerts.
  • Patient education infographic on hypoglycemia and glucagon.

Association of Diabetes Care & Education Specialists

Contact Us