Summary And Perspective

Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and a barrier to true glycemic control and its established long-term vascular benefits. Hypoglycemia is less frequent overall in type 2 diabetes, compared with type 1 diabetes, because glucose counterregulatory defenses remain intact early in the course of type 2 diabetes. However, iatrogenic hypoglycemia becomes a progressively more frequent problem, ultimately approaching that in type 1 diabetes, as patients approach the insulin-deficient end of the spectrum of type 2 diabetes because of compromised physiological and behavioral defenses against developing hypoglycemia. The syndromes of defective glucose counterregulation and hypoglycemia unawareness, and the concept of HAAF, in advanced (insulin deficient) type 2 diabetes are analogous to those that develop early in the course of type 1 diabetes. By practicing hypoglycemia risk reduction, i.e., addressing the issue, applying the principles of aggressive glycemic therapy, and considering both the conventional risk factors and those indicative of compromised defenses against hypoglycemia, healthcare providers should strive to reduce mean glycemia as much as can be accomplished safely. Clearly, given current treatment limitations, people with diabetes need more physiological approaches to glycemic control, tailored to their degree of insulin deficiency.

Hypoglycemia should not be used, by the provider or the patient, as an excuse for poor glycemic control, particularly in view of the growing array of glucose-lowering drugs that can be used to optimize therapy and achieve the best control possible in a given patient with type 2 diabetes. Nonetheless, better methods—such as those that would provide glucose-regulated insulin replacement or secretion—are clearly needed for people with type 2 diabetes, as well as for those with type 1 diabetes, if we are to maintain euglycemia over a lifetime of diabetes.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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