Insulin therapy and hypoglycaemia: the size of the problem
Article first published online: 18 NOV 2004
Copyright © 2004 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews
Volume 20, Issue S2, pages S32–S42, November/December 2004
How to Cite
Fanelli, C. G., Porcellati, F., Pampanelli, S. and Bolli, G. B. (2004), Insulin therapy and hypoglycaemia: the size of the problem. Diabetes Metab. Res. Rev., 20: S32–S42. doi: 10.1002/dmrr.514
- Issue published online: 18 NOV 2004
- Article first published online: 18 NOV 2004
- Manuscript Accepted: 15 JUN 2004
- Manuscript Revised: 10 MAY 2004
- Manuscript Received: 20 MAR 2004
- intensive insulin therapy;
- hypoglycaemia unawareness;
- continous glucose monitoring system (CGMS)
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.
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 (A1c) 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.
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 DM. Copyright © 2004 John Wiley & Sons, Ltd.