Hypoglycemic response in the elderly with neurological symptoms as the main manifestation Diabetes can lead to microvascular and macroangiopathy, affecting all organs of the body. In 2007, the European Society of Cardiology and the European Diabetes Association jointly formulated the joint ESC/EASD guidelines on diabetes, prediabetes and cardiovascular disease, which include hyperglycemia as one of the risk factors for cardiovascular disease and emphasize the importance of diabetes management for the prevention of cardiovascular disease. The control targets of fasting blood glucose <6.2mmol/L, postprandial blood glucose <8mmol/L and glycosylated hemoglobin HbA1c <6.5% are proposed, which are consistent with the 2004 guidelines for the prevention and treatment of diabetes in China. This requires us to strictly control blood glucose, control diet and precisely regulate drug therapy. Insulin therapy is applicable to type 1 diabetes and late type 2 diabetes. In recent years, with the improvement of diabetes control goals, the number of elderly type 2 diabetes patients has increased, mostly combined with impaired cardiac, renal and gastrointestinal functions, and insulin therapy is more commonly used in clinical practice. As the automatic regulation of blood sugar in diabetic patients disappears, blood sugar fluctuates greatly with the body's diet, activities and the amount of exogenous insulin dosage, several of the above factors can affect the level of blood sugar, and even weather changes, mood swings and sleep quality can affect the metabolic situation of blood sugar. Therefore, the stricter the control of blood sugar, the more likely it is to produce hypoglycemic reactions. And hypoglycemia can be a serious blow to the patients, which can be dizziness, hunger, palpitation, fall, trauma and coma, also can be complicated by fracture and lung infection, and even acute cardiovascular and cerebrovascular accidents. In our clinical work, we always have to inform patients of the common manifestations of hypoglycemia: hunger, rapid heartbeat, dizziness, cold sweat, etc., in order to detect them early and try to avoid serious hypoglycemic reactions. However, for the elderly, some of the above hypoglycemic reactions may not be obvious due to the long duration of the disease, weakened sympathetic nerve reactivity and various sensory decreases. The author recently encountered 2 cases of hypoglycemia with neurological reactions as the main manifestation, which are introduced as follows to share with you: Male, 84 years old, suffering from diabetes for 30 years, had been treated with oral hypoglycemic drugs and changed to mixed insulin treatment in the past 5 years, but his blood glucose was still relatively high. 3 months ago, he changed to insulin pump treatment, and his blood glucose was satisfactorily controlled, but he developed visual flash sensation, which was also not regular, and went to the ophthalmologist for examination. No abnormality was found. Until one day before lunch, after the visual flash, he became dizzy, fell to bed, became hazy, talked nonsense and did not respond to calls. The rapid blood glucose was measured and found to be 2.4mmol/L, immediately injected intravenously with glucose, then woke up, and a few days later had a similar attack, rapid blood glucose was 2.8mmol/L. After appropriate reduction of insulin pump dose, the visual flash symptoms disappeared, and rapid blood glucose was measured several times at 7-12mmol/L. In another case, a 75-year-old male, found to be diabetic for 3 years. He was injected with Novolin 30R mixed insulin twice a day subcutaneously, and measured pre- and post-prandial fast glucose basically in the normal range (4.4-7.8 mmol/L), but since the insulin was used, he had symptoms of excessive dreaming, talking in his sleep, fighting with people in his dreams or dreaming of fighting, moving his hands and feet around in his sleep, and even falling off the bed and falling with a bruised nose. No significant abnormality was found in the cranial CT examination, and the EEG examination was normal. After hospitalization to check the nocturnal blood glucose, it was found that the nocturnal blood glucose was 3.4 mmol/L. Subsequently, the insulin dose was reduced, and the excessive dreaming disappeared and the sleep was peaceful. The above example reminds us that we must do a good job of patient propaganda and education before insulin treatment, teach patients as well as their family members to observe the reaction of hypoglycemia, and strictly control blood glucose while the dose needs to be carefully adjusted and not overdosed, otherwise it will cause hypoglycemia. For elderly patients, it is especially important to note that common hypoglycemic reactions such as hunger sensation and cold sweat may not be obvious. Blood glucose should be measured diligently and insulin dose should be fine-tuned in small doses to avoid severe hypoglycemia.