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Insulin therapy and hypoglycaemia: the size of the problem
Author(s) -
Fanelli Carmine G.,
Porcellati Francesca,
Pampanelli Simone,
Bolli Geremia B.
Publication year - 2004
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.514
Subject(s) - medicine , insulin , diabetes mellitus , asymptomatic , hypoglycemia , endocrinology , basal (medicine) , glycated hemoglobin , insulin glargine , type 1 diabetes , type 2 diabetes
Abstract Background and Methods Hypoglycaemia is a fact of life for people with diabetes mellitus. Mild, asymptomatic episodes occur once or twice a week in insulin‐treated diabetic subjects. Asymptomatic hypoglycaemia, including nocturnal hypoglycaemia, occurs in about 25% of diabetic subjects treated with insulin therapy. Mild hypoglycaemia, if recurrent, induces unawareness of hypoglycaemia and impairs glucose counterregulation, which in turn predisposes to severe hypoglycaemia. Even brief hypoglycaemia can cause profound dysfunction of the brain. Prolonged, severe hypoglycaemia can cause permanent neurological sequels. In addition, it is possible that hypoglycaemia may accelerate the vascular complications of diabetes by increasing platelet aggregation and/or fibrinogen formation. Finally, hypoglycaemia may be fatal. Hypoglycaemia induced by insulin as treatment of type 1 diabetes mellitus (T1 DM) is not the consequence of diabetes, but invariably of the non‐physiological replacement of insulin. Results A number of studies have demonstrated that by moving from non‐physiological to more physiological models of insulin therapy, most of the hypoglycaemia problems may be overcome, the percentage of glycated hemoglobin (A 1c ) decreased, and the quality of life improved. Interestingly, in T1 DM with hypoglycaemia unawareness, prevention of hypoglycaemia reverses not only unawareness but also improves glucose counterregulation, primarily the responses of adrenaline. Conclusions In order to best prevent hypoglycaemia, insulin should preferably be given as continuous subcutaneous infusion via a minipump (the ‘golden standard’) or multiple daily insulin administrations with insulin analogues (basal insulin glargine, meal insulin rapid‐acting insulin analogues) in T1 D M. Copyright © 2004 John Wiley & Sons, Ltd.