Pathophysiology and management of recurrent hypoglycaemia and hypoglycaemia unawareness in diabetes.

摘要: Iatrogenic hypoglycaemia is a well-known complication of insulin therapy in patients with diabetes mellitus and limiting factor for glycaemic control. In setting endogenous deficiency (type 1 advanced type 2 diabetes), one episode reduces both counterregulatory hormone responses to subjective awareness subsequent hypoglycaemia, thus impairing physiological defences against hypoglycaemia. This phenomenon may lead vicious cycle recurrent glucose failure, which unawareness (i.e. the inability perceive symptoms hypoglycaemia) clinical representative. The underlying mechanism hypoglycaemia-induced failure has not yet been disclosed. Patients are at high risk severe that requires third-party assistance. Management options include avoidance hypoglycaemic events optimisation limit deterioration control associated avoidance. Several counterregulatory-stimulating agents have found improve small trials, but none tested sufficiently large randomised studies justify their use daily practice. More research required elucidate pathogenesis develop adequate treatment strategies.