Letter to the Editor

Hypoglycemia Unawareness and Type 1 Diabetes

Authors: Steven V. Edelman, MD, Candis M. Morello, PharmD CDE

Abstract

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 β-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 accomplish this objective. We report a patient with type 1 diabetes presenting with poorly controlled diabetes, recent episodes of severe hypoglycemia, and hypertension and hyperlipidemia.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metab2001;281:E1115–E1121.
 
2. Cranston I, Lomas J, Maran A, et al. Restoration of hypoglycemia awareness in patients with long-duration insulin-dependent diabetes. Lancet 1994;344:283–287.
 
3. Oltmanns KM, Deininger E, Wellhoener P, et al. Influence of captopril on symptomatic and hormonal responses to hypoglycemia in humans. Br J Clin Pharmacol 2003;55:347–353.
 
4. Heinemann L, Linkeschova R, Rave K, et al. Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo. Diabetes Care2000;23:644–649.
 
5. Raskin P, Klaff L, Bergenstal R, et al. A 16-week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes.Diabetes Care 2000;23:1666–1671.