title: Managing hypoglycaemia.
abstract: Intensive glycaemic control reduces the diabetic microvascular disease burden but iatrogenic hypoglycaemia is a major barrier preventing tight glycaemic control because of the limitations of subcutaneous insulin preparations and insulin secretagogues. Severe hypoglycaemia is uncommon early in the disease as robust physiological defences, particularly glucagon and adrenaline release, limit falls in blood glucose whilst associated autonomic symptoms drive patients to take action by ingesting oral carbohydrate. With increasing diabetes duration, glucagon release is progressively impaired and sympatho-adrenal responses are activated at lower glucose levels. Repeated hypoglycaemic episodes contribute to impaired defences, increasing the risk of severe hypoglycaemia in a vicious downward spiral. Managing hypoglycaemia requires a systematic clinical approach with structured insulin self-management training and support of experienced diabetes educators. Judicious use of technologies includes insulin analogues, insulin pump therapy, continuous glucose monitoring, and in a few cases islet cell transplantation. Some individuals require specialist psychological support.
authors.affiliation: Department of Human Metabolism and Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: ahmed.iqbal@sheffield.ac.uk.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Department of Human Metabolism and Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: s.heller@sheffield.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D019468:Disease Management; D005934:Glucagon / Q000097:blood; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D007328:Insulin / Q000009:adverse effects / Q000097:blood
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005934:Glucagon
keywords: adrenaline; cardiovascular risk; counter-regulation; hypoglycaemia; impaired hypoglycaemia awareness