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Article Excerpt
To the Editor: Hypoglycemia is a major limiting factor in treating patients with type 1 diabetes and may have serious, life-threatening consequences. Patients with repeated hypoglycemic episodes can have hypoglycemia unawareness, a condition characterized by a progressive loss of the symptoms associated with the autonomic response to hypoglycemia, for example, sweating, tremor, anxiety, and palpitations. (1) Development of this syndrome may be influenced by the presence of autonomic neuropathy, duration of diabetes, the use of [beta]-blockers, or utilization of intensive glycemic control. Hypoglycemia unawareness can be reversed, however, by strict avoidance of hypoglycemia for even a few days. (2) From a treatment perspective, the closer the pattern of insulin replacement is to physiologic secretion, the lower the risk of hypoglycemia. Substituting insulin regimens that more closely mimic physiologic secretion, along with adjustments of concomitant medications, can help...
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