What is it about?
This case report describes a 77-year-old woman with long-standing hot flashes, originally thought to be related to menopause. Despite normal hormone tests and appropriate HbA1c levels (7.1%), her symptoms worsened at night and were accompanied by heavy sweating. Continuous glucose monitoring (CGM) revealed repeated episodes of nocturnal hypoglycemia while on sulfonylurea therapy (glimepiride). When the glimepiride dose was reduced—and later discontinued—her hot flashes and sweating resolved.
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Why is it important?
Atypical presentation: Hot flashes in women over 70 are unlikely to be menopausal, but may mask other conditions such as hypoglycemia. HbA1c limitations: HbA1c does not reflect daily glucose fluctuations; patients may have hypoglycemia despite “good” average glucose control. Older patients at risk: Age, comorbidities, and multiple medications increase vulnerability to hypoglycemia, often with atypical or unrecognized symptoms. CGM as a diagnostic tool: CGM can uncover hidden glucose variability, linking unexplained symptoms to underlying hypoglycemia and guiding safer treatment adjustments.
Perspectives
Clinical takeaway: In older adults with diabetes, unexplained symptoms like hot flashes or night sweats should prompt consideration of hypoglycemia, even with apparently well-controlled HbA1c. Role of CGM: Provides detailed glucose patterns and can reveal causes of nonspecific symptoms, helping personalize therapy. Therapeutic caution: Adjusting or discontinuing hypoglycemic drugs (like sulfonylureas) may relieve symptoms, but glucose management must remain carefully balanced. Broader implication: This case highlights the importance of shifting from reliance on HbA1c alone to more dynamic monitoring in geriatric diabetes care.
Prof Takuya Omura
National Center for Geriatrics and Gerontology
Read the Original
This page is a summary of: Identification of atypical hypoglycemia via continuous glucose monitoring in a patient presenting with hot flashes, Journal of General and Family Medicine, July 2024, Wiley,
DOI: 10.1002/jgf2.718.
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