Treatment of Mild Hypoglycemia

> “Let food be thy medicine and medicine be thy food.” > > —Hippocrates It has been well established by studies such as the landmark Diabetes Control and Complications Trial (DCCT) that metabolic control delays the development and progression of microvascular complications in adults with type 1 diabetes.1 Unfortunately, improvement in metabolic control is associated with an increased incidence of treatment-induced hypoglycemia. This is a common side effect of insulin, as well as the insulin secretagogues frequently used in the treatment of type 2 diabetes.2As insulin secretion diminishes in type 2 diabetes, hypoglycemia becomes more frequent and limiting. Five years after initiation of insulin therapy, the rate of severe hypoglycemia is reported to be as high as 35–70 episodes per 100 patient-years, higher than that in type 1 diabetes.3,4 Abnormal glucose counterregulation (and hypoglycemia unawareness) progresses based on the progression of insulin deficiency. Thus, because type 2 diabetes is more prevalent than type 1 diabetes, most episodes of hypoglycemia occur in people with type 2 diabetes.2In both type 1 and type 2 diabetes, counterregulatory responses to hypoglycemia steadily decline with frequent and repetitive episodes.2 This can become a vicious circle; a hypoglycemia episode impairs defenses against a subsequent episode, and thus hypoglycemia can result in recurrent hypoglycemia. Hypoglycemia causes increased morbidity in most people with type 1 diabetes and in many with a long duration of type 2 diabetes and is sometimes fatal.2There is growing evidence that older adults with known cardiovascular disease (CVD)5–8 and very young children who cannot independently recognize low glucose levels may be particularly vulnerable to adverse events associated with hypoglycemia.9,10 Findings such as these led a workgroup from the American Diabetes Association (ADA) and The Endocrine Society (TES) to publish a …