Hypoglycemia-associated autonomic failure in diabetes.

摘要: Hypoglycemia is the limiting factor in glycemic management of diabetes. The concept hypoglycemia-associated autonomic failure (HAAF) diabetes posits that recent antecedent iatrogenic hypoglycemia causes both defective glucose counterregulation (by reducing epinephrine response to falling levels setting an absent glucagon response) and unawareness resulting neurogenic symptom responses) thus a vicious cycle recurrent hypoglycemia. Perhaps most compelling support for HAAF finding as little 2-3 wk scrupulous avoidance reverses improves reduced component affected individuals. Insight into this pathophysiology has led broader view clinical risk factors include indexes compromised provided framework study mechanisms and, ultimately, its elimination from lives people with