Hypoglycemia in Type 1 Diabetes Mellitus

Overview

Journal Endocrinol Metab Clin North Am

Publisher Elsevier

Specialty Endocrinology

Date 2010 Aug 21

PMID 20723825

Citations 74

Authors

Philip E Cryer

Affiliations

Soon will be listed here.

Abstract

Iatrogenic hypoglycemia, typically the result of the interplay of therapeutic hyperinsulinemia and compromised defenses resulting in hypoglycemia-associated autonomic failure (HAAF) in diabetes, is a problem for people with type 1 diabetes mellitus (T1DM). It causes recurrent morbidity is sometimes fatal, leads to recurrent hypoglycemia, and precludes euglycemia over a lifetime of T1DM. Risk factors include those that result in relative or absolute insulin excess and those indicative of HAAF in diabetes. Elimination of hypoglycemia from the lives of people with T1DM will likely be accomplished by new treatment methods that provide plasma glucose-regulated insulin replacement or secretion.

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References

Cryer P, Davis S, Shamoon H . Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6):1902-12. DOI: 10.2337/diacare.26.6.1902. View

Arbelaez A, Powers W, Videen T, Price J, Cryer P . Attenuation of counterregulatory responses to recurrent hypoglycemia by active thalamic inhibition: a mechanism for hypoglycemia-associated autonomic failure. Diabetes. 2007; 57(2):470-5. PMC: 2435187. DOI: 10.2337/db07-1329. View

Fanelli C, Pampanelli S, EPIFANO L, Rambotti A, Di Vincenzo A, Modarelli F . Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Diabetologia. 1994; 37(12):1265-76. DOI: 10.1007/BF00399801. View

. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med. 1991; 90(4):450-9. View

Geddes J, Schopman J, Zammitt N, Frier B . Prevalence of impaired awareness of hypoglycaemia in adults with Type 1 diabetes. Diabet Med. 2008; 25(4):501-4. DOI: 10.1111/j.1464-5491.2008.02413.x. View

. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007; 50(6):1140-7. DOI: 10.1007/s00125-007-0599-y. View

Huang E, Zhang Q, Gandra N, Chin M, Meltzer D . The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med. 2008; 149(1):11-9. PMC: 2562733. DOI: 10.7326/0003-4819-149-1-200807010-00005. View

Skyler J, Bergenstal R, Bonow R, Buse J, Deedwania P, Gale E . Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of.... Diabetes Care. 2008; 32(1):187-92. PMC: 2606812. DOI: 10.2337/dc08-9026. View

Skrivarhaug T, Bangstad H, Stene L, Sandvik L, Hanssen K, Joner G . Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia. 2005; 49(2):298-305. DOI: 10.1007/s00125-005-0082-6. View

10.

Boyle P, Schwartz N, Shah S, Clutter W, Cryer P . Plasma glucose concentrations at the onset of hypoglycemic symptoms in patients with poorly controlled diabetes and in nondiabetics. N Engl J Med. 1988; 318(23):1487-92. DOI: 10.1056/NEJM198806093182302. View

11.

Dagogo-Jack S, Rattarasarn C, Cryer P . Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes. 1994; 43(12):1426-34. DOI: 10.2337/diab.43.12.1426. View

12.

Fatourechi M, Kudva Y, Murad M, Elamin M, Tabini C, Montori V . Clinical review: Hypoglycemia with intensive insulin therapy: a systematic review and meta-analyses of randomized trials of continuous subcutaneous insulin infusion versus multiple daily injections. J Clin Endocrinol Metab. 2008; 94(3):729-40. DOI: 10.1210/jc.2008-1415. View

13.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

14.

Mukhopadhyay A, Farrell T, Fraser R, Ola B . Continuous subcutaneous insulin infusion vs intensive conventional insulin therapy in pregnant diabetic women: a systematic review and metaanalysis of randomized, controlled trials. Am J Obstet Gynecol. 2007; 197(5):447-56. DOI: 10.1016/j.ajog.2007.03.062. View

15.

Gough S . A review of human and analogue insulin trials. Diabetes Res Clin Pract. 2006; 77(1):1-15. DOI: 10.1016/j.diabres.2006.10.015. View

16.

Heller S, Cryer P . Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia after 1 episode of hypoglycemia in nondiabetic humans. Diabetes. 1991; 40(2):223-6. DOI: 10.2337/diab.40.2.223. View

17.

Nathan D, Cleary P, Backlund J, Genuth S, Lachin J, Orchard T . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005; 353(25):2643-53. PMC: 2637991. DOI: 10.1056/NEJMoa052187. View

18.

Gerich J, Langlois M, Noacco C, KARAM J, FORSHAM P . Lack of glucagon response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha cell defect. Science. 1973; 182(4108):171-3. DOI: 10.1126/science.182.4108.171. View

19.

Banarer S, Cryer P . Sleep-related hypoglycemia-associated autonomic failure in type 1 diabetes: reduced awakening from sleep during hypoglycemia. Diabetes. 2003; 52(5):1195-203. DOI: 10.2337/diabetes.52.5.1195. View

20.

. Hypoglycemia in the Diabetes Control and Complications Trial. The Diabetes Control and Complications Trial Research Group. Diabetes. 1997; 46(2):271-86. View