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Type 1 Diabetes Hypoglycemia

Jci -hypoglycemia Unawareness In Type 1 Diabetes Suppresses Brain Responses To Hypoglycemia

Jci -hypoglycemia Unawareness In Type 1 Diabetes Suppresses Brain Responses To Hypoglycemia

Clinical Medicine Endocrinology Free access | 10.1172/JCI97696 Hypoglycemia unawareness in type 1 diabetes suppresses brain responses to hypoglycemia 2Department of Radiology & Biomedical Imaging, and 3Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. 4Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA. 5Department of Cardiology, Nephrology and Endocrinology, Nordsjllands Hospital, Hillerd, Denmark. Address correspondence to: Robert S. Sherwin, The Anlyan Center, TAC 147S, PO Box 208020, New Haven, Connecticut 06520, USA. Phone: 203.785.4183; Email: [email protected] . Find articles by Hwang, J. in: JCI | PubMed | Google Scholar 2Department of Radiology & Biomedical Imaging, and 3Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. 4Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA. 5Department of Cardiology, Nephrology and Endocrinology, Nordsjllands Hospital, Hillerd, Denmark. Address correspondence to: Robert S. Sherwin, The Anlyan Center, TAC 147S, PO Box 208020, New Haven, Connecticut 06520, USA. Phone: 203.785.4183; Email: [email protected] . Find articles by Parikh, L. in: JCI | PubMed | Google Scholar 2Department of Radiology & Biomedical Imaging, and 3Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. 4Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA. 5Department of Cardiology, Nephrology and Endocrinology, Nordsjllands Hospital, Hillerd, Denmark. Address correspondence to: Robert S. Sherwin, The Anlyan Center, TAC 147S, PO Box 208020, New Haven, Connecticut 06520, USA. Phone: 203.785.4183; Email: [email protected] . Find art Continue reading >>

Diabetes And Hypoglycemia

Diabetes And Hypoglycemia

Tweet Hypoglycemia occurs when blood glucose levels fall below 4 mmol/L (72mg/dL). Whilst many of us think of diabetes as being a problem of high blood sugar levels, the medication some people with diabetes take medication that can also cause their sugar levels to go too low and this can become dangerous. What is hypoglycemia? Hypoglycemia occurs when the level of glucose present in the blood falls below a set point: Below 4 mmol/L (72mg/dL) Being aware of the early signs of hypoglycemia will allow you to treat your low blood glucose levels quickly - in order to bring them back into the normal range. It is also recommended to make close friends and family aware of the signs of hypoglycemia in case you fail to recognise the symptoms. What are the symptoms of hypoglycemia? The main symptoms associated with hypoglycemia are: Sweating Feeling dizzy Symptoms of hypoglycemia can also include: Being pale Feeling weak Feeling hungry A higher heart rate than usual Blurred vision Confusion Convulsions Loss of consciousness And in extreme cases, coma Who is at risk of hypos? Whilst low blood sugar can happen to anyone, dangerously low blood sugar can occur in people who take the following medication: Sulphopnylureas (such as glibenclamide, gliclazide, glipizide, glimepiride, tolbutamide) Prandial glucose regulators (such as repaglinide, nateglinide) If you are not sure whether your diabetes medication can cause hypos, read the patient information leaflet that comes with each of your medications or ask your doctor. It is important to know whether your diabetes medication puts you at risk of hypos. What are the causes of hypoglycemia? Whilst medication is the main factor involved in hypoglycemia within people with diabetes, a number of other factors can increase the risk of hypos oc Continue reading >>

When Insulin Works Too Well: Part 1: Hypoglycemia In Type 1 Diabetics

When Insulin Works Too Well: Part 1: Hypoglycemia In Type 1 Diabetics

Hypoglycemia is one of the most common side effects of insulin treatment of diabetes. Current management of type 1 diabetes includes a regimen of strict glycemic control with intensive insulin therapy. This tight control of blood glucose levels is key in reducing the risk of microvascular complications and improving daily quality of life. However, the risk of hypoglycemia increases with this treatment model. Even with the development of new insulin analogs and pump delivery methods, the average T1D patient will experience about two mild (self-treated) episodes of symptomatic hypoglycemia per week, a figure that has not changed in the last 20 years. (1) Frier estimates to annual prevalence of severe hypoglycemia (requiring external help) to be 30% for T1D patients, and even higher in those with risk factors such as strict glycemic control, impaired awareness of hypoglycemic symptoms, and increasing duration of diabetes. (2) Hypoglycemia in diabetes can be defined as the occurrence of a wide variety of symptoms in association with a plasma glucose concentration of: 50 mg/dL or less in men 45 mg/dL or less in women 40 mg/dL or less in infants and children Hypoglycemic Symptoms: (3) Autonomic Neuroglycopenic General Malaise Shaking Palpitations Sweating Hunger Pallor Anxiety Confusion Drowsiness Odd behavior Difficulty speaking Incoordination Dizziness Vision disturbances Headache Nausea Treatment and Management of Hypoglycemia: (4) Pre-Hospital Care: EMS response consists of performing a serum glucose/Accucheck prior to administering dextrose 50% (D50) in the field. When uncertain, administration will help determine if hypoglycemia is present. If the patient is awake, or awakens following administration of D50, further treatment or transport to the ED for evaluation may be Continue reading >>

Type 1 Diabetes Low Blood Sugar Symptoms

Type 1 Diabetes Low Blood Sugar Symptoms

Type 1 diabetes in an autoimmune disease where a person’s pancreas doesn’t produce insulin—a hormone needed to convert food into energy. It affects children and adults, comes on suddenly, and it cannot be prevented or cured. Hypoglycemia, or low blood sugar, is a common and dangerous occurance with type 1 diabetes. If your blood sugar gets too low it may lead to insulin shock, which is life-threatening if not cared for. Low blood sugar can happen when your body has too little food—or glucose—or when it produces too much insulin. Type 1 diabetes hypoglycemia symptoms So what are the low blood sugar symptoms you should look out for? It’s important to realize that the signs of low blood sugar will vary depending on the person. However, people with type 1 diabetes—whether it’s been diagnosed or not—may experience one or more of the following: -Sweating and shaking -Blurry vision -Poor coordination -Dizziness or feeling lightheaded -Difficulty concentrating -Feeling anxious or irritable -Hunger or nausea -Erratic changes in behavior What to do if you experience low blood glucose symptoms Severely low blood-sugar levels can lead to hypoglycemic seizures, unconsciousness, coma, and death if left untreated. That’s why it’s important to see a doctor if you think you have low blood sugar so he or she can check your blood-glucose levels—look into whether type 1 diabetes may be a cause—and provide the necessary treatment. Your support is more critical than ever Continue reading >>

Diabetic Hypoglycemia

Diabetic Hypoglycemia

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an estimated 55,819 cases (8.0% of total admissions) involved insulin, and severe hypoglycemia is likely the single most common event.[1] In general, hypoglycemia occurs when a treatment to lower the elevated blood glucose of diabetes inaccurately matches the body's physiological need, and therefore causes the glucose to fall to a below-normal level. Definition[edit] A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl (3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can sometimes occur at higher glucose levels, or may fail to occur at lower. Some textbooks for nursing and pre-hospital care use the range 80 mg/dl to 120 mg/dl (4.4 mmol/l to 6.7 mmol/l). This variability is further compounded by the imprecision of glucose meter measurements at low levels, or the ability of glucose levels to change rapidly. Signs and symptoms[edit] Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it". A co-morbidity is the issue of hypoglycemia unawareness. Recent research using machine learning methods have proved to Continue reading >>

Hypoglycemia In Type 1 Diabetes

Hypoglycemia In Type 1 Diabetes

In subjects with type 1 diabetes, autoimmune destruction of pancreatic β-cells leads eventually to an absolute requirement for insulin replacement therapy. Insulin delivered exogenously is not subject to normal physiological feedback regulation, so it may induce hypoglycemia even in the presence of an intact counterregulatory response. The average individual with type 1 diabetes experiences about two episodes of symptomatic hypoglycemia per week, a figure that has not changed substantially in the last 20 years (1). Severe hypoglycemia (requiring help for recovery) has an annual prevalence of 30–40% and an annual incidence of 1.0 – 1.7 episodes per patient per year (1). This risk is increased markedly with the increasing duration of the disease and strict glycemic control. In subjects with type 2 diabetes, the increasing duration of the disease and the more widespread use of insulin therapy also increase the risk of severe hypoglycemia. This was reflected in a recent survey in Tayside, Scotland, which found the proportion of severe hypoglycemic episodes needing emergency medical assistance was similar between type 1 and insulin-treated type 2 diabetic patients (2). The experience of hypoglycemia is not limited to a transient impairment of cognition. We now recognize that hypoglycemia carries with it a recognized morbidity and mortality (3) and creates a negative mood-state characterized by reduced energy and increased tension (4). This may explain why hypoglycemia is greatly feared by individuals with diabetes; so much so that the fear of hypoglycemia is rated with the same degree of concern as the development of sight-threatening retinopathy or end-stage renal disease. This fear of hypoglycemia influences an individual's ability to adhere to optimal insulin replace Continue reading >>

Diabetic Hypoglycemia

Diabetic Hypoglycemia

Print Overview For people with diabetes, low blood sugar (hypoglycemia) occurs when there's too much insulin and not enough sugar (glucose) in the blood. Hypoglycemia is defined as blood sugar below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L). Several factors can cause hypoglycemia in people with diabetes, including taking too much insulin or other diabetes medications, skipping a meal, or exercising harder than usual. Pay attention to early warning signs, so you can treat low blood sugar promptly. Treatment involves short-term solutions — such as taking glucose tablets — to raise your blood sugar into a normal range. Untreated, diabetic hypoglycemia can lead to seizures and loss of consciousness — a medical emergency. Rarely, it can be deadly. Tell family and friends what symptoms to look for and what to do in case you're not able to treat the condition yourself. Symptoms Early warning signs and symptoms Early signs and symptoms of diabetic hypoglycemia include: Shakiness Dizziness Sweating Hunger Irritability or moodiness Anxiety or nervousness Headache Nighttime symptoms Diabetic hypoglycemia can also occur while you sleep. Signs and symptoms, which can awaken you, include: Damp sheets or bedclothes due to perspiration Nightmares Tiredness, irritability or confusion upon waking Severe symptoms If diabetic hypoglycemia goes untreated, signs and symptoms of severe hypoglycemia can occur. These include: Clumsiness or jerky movements Muscle weakness Difficulty speaking or slurred speech Blurry or double vision Drowsiness Confusion Convulsions or seizures Unconsciousness Death Take your symptoms seriously. Diabetic hypoglycemia can increase the risk of serious — even deadly — accidents. Identifying and correcting the factors contrib Continue reading >>

Hypoglycemia In Children With Type 1 Diabetes

Hypoglycemia In Children With Type 1 Diabetes

Hypoglycemia, or low blood glucose (blood sugar), is a common complication that can occur with diabetes. The challenge for parents of children with type 1 diabetes is to know how to detect the symptoms of hypoglycemia and effectively treat it. This article addresses both those considerations. But first, it's important to have a solid understanding of hypoglycemia. EndocrineWeb has a comprehensive article series on this complication—and we invite you to read them to learn more. Below is a selection of hypoglycemia resources to get you started: Detecting Hypoglycemia Hypoglycemia occurs when your child's blood glucose levels fall below his or her target range. Target ranges are determined by your child's doctor and are unique to each child. For instance, your child may feel fine with a blood glucose reading of 70, but another child could show hypoglycemia symptoms with a reading slightly above 70.1 Knowing your child's target range and ensuring his or her blood glucose level stays within it is the main objective. If hypoglycemia isn't detected early on, it can cause serious problems, such as seizure or loss of consciousness. So what can you do to prevent your child's hypoglycemia from becoming a potentially serious problem? First and foremost, you should understand the symptoms. These include: Sweating Hunger Dizziness and difficulty concentrating Shakiness Headache Fatigue Pale skin Irritability Make sure that you, your family, and your child can identify the most common hypoglycemia symptoms. Treating Hypoglycemia You should talk with your doctor for specific recommendations on how to treat your child if he or she experiences an episode of hypoglycemia. But, generally, if your child has a low blood glucose meter reading and is showing hypoglycemia symptoms, the goal i Continue reading >>

Recurrent Nocturnal Hypoglycemia In A Patient With Type 1 Diabetes Mellitus

Recurrent Nocturnal Hypoglycemia In A Patient With Type 1 Diabetes Mellitus

A 39-year-old man with type 1 diabetes mellitus (DM) was admitted with diabetic ketoacidosis precipitated by an upper respiratory tract infection. His admitting biochemistry showed venous plasma glucose concentration of 933 mg/dL (51.8 mmol/L) [reference: 72–140 mg/dL (4.0–7.8 mmol/L)], bicarbonate of 14.7 mmol/L (22–31 mmol/L), β-hydroxybutyrate of >6 mmol/L (<0.6 mmol/L), and arterial pH of 7.28 (7.35–7.45). He was treated with intravenous hydration and intravenous insulin infusion, and made a rapid recovery. The patient had been diagnosed with type 1 DM at the age of 33 years when he presented with diabetic ketoacidosis. Glutamic acid decarboxylase antibody was increased at the time of diagnosis [10.6 U/mL (reference: <1 U/mL)] and postprandial C-peptide concentrations were undetectable. His subsequent glycemic control was poor [glycated hemoglobin (Hb A1c) ranged from 8.9% to 15.6%], which resulted in peripheral and autonomic neuropathy manifesting as painful sensory neuropathy and erectile dysfunction, respectively. His other medical history included mitral valve prolapse, hypertension, and dyslipidemia. He was prescribed a basal-bolus insulin regimen consisting of twice-daily insulin detemir (10 U before breakfast and 7 U before dinner) and insulin aspart (5 U before breakfast, 3 U before lunch, and 4 U before dinner), simvastatin, sildenafil, pregabalin, and omeprazole. He was not prescribed sulfonylurea and denied alcohol consumption. After resolution of diabetic ketoacidosis, the patient was restarted on his preadmission basal-bolus insulin regimen. His insulin regimen was titrated during this hospital admission, and he had wide fluctuations in blood glucose and recurrent nocturnal hypoglycemia. Typically, there was severe hyperglycemia during daytime Continue reading >>

Insulin Analogues And Hypoglycemia In Patients With Type 1 Diabetes—reply

Insulin Analogues And Hypoglycemia In Patients With Type 1 Diabetes—reply

In Reply The SWITCH 1 trial was the first trial, to our knowledge, to investigate hypoglycemia as a primary outcome in patients with type 1 diabetes, comparing insulin degludec with insulin glargine. Personalizing fasting blood glucose targets for patients remains important in clinical practice. However, in the trial, identical fasting blood glucose target goals and noninferior HbA1c values were imperative for analysis of the primary outcome of hypoglycemia. The protocol included algorithms for up- or down-titration of the insulin dose to achieve target fasting blood glucose levels of 71 mg/dL to 90 mg/dL; titration was conducted at the investigator’s discretion, so at no time was patient safety compromised. Targeting a higher fasting blood glucose would not facilitate achieving HbA1c values of less than 7%, as recommended by the American Diabetes Association1 or less than 6.5%, as recommended by the American Association of Clinical Endocrinologists.2 Achieving a fasting blood glucose target of less than 110 mg/dL and a HbA1c target less than 7% proved difficult in past treat-to-target trials using older insulins, and earlier landmark studies showed that intensive treatment aimed at reducing microvascular and macrovascular complications increased hypoglycemia risk.3 Aiming for higher blood glucose targets in the management of type 1 diabetes implies a conservative approach to avoid hypoglycemia, in part reflecting a past era of older insulins, which were shorter acting and with more variable and less-predictable time-action profiles than newer basal insulin analogues. Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes can occur at any age. It is most often diagnosed in children, adolescents, or young adults. Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. With type 1 diabetes, beta cells produce little or no insulin. Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. This buildup of glucose in the blood is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 1 diabetes. The exact cause of type 1 diabetes is unknown. Most likely, it is an autoimmune disorder. This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1 diabetes, an infection or another trigger causes the body to mistakenly attack the cells in the pancreas that make insulin. The tendency to develop autoimmune diseases, including type 1 diabetes, can be passed down through families. Continue reading >>

Nocturnal Hypoglycemia In Type 1 Diabetes: An Assessment Of Preventive Bedtime Treatments

Nocturnal Hypoglycemia In Type 1 Diabetes: An Assessment Of Preventive Bedtime Treatments

Objective: We assessed four putative bedtime treatments in the prevention of nocturnal hypoglycemia in type 1 diabetes. Research Design and Methods: Plasma glucose concentrations were measured every 15 min from 2200 h through 0700 h in 21 patients with type 1 diabetes (mean ± sd HbA1C = 7.1 ± 1.0%) on five occasions with, in random sequence, bedtime (2200 h) administration of 1) no treatment, 2) a snack, 3) the snack plus the α-glucosidase inhibitor acarbose, 4) an uncooked cornstarch bar, or 5) the β2-adrenergic agonist terbutaline. Results: In the absence of a bedtime treatment, 27% of the measured nocturnal plasma glucose concentrations were less than 70 mg/dl (3.9 mmol/liter) in 12 patients; 16, 6, and 1% were less than 60, less than 50, and less than 40 mg/dl (3.3, 2.8, and 2.2 mmol/liter), respectively. Neither the snack (without or with acarbose) nor cornstarch raised the mean nadir nocturnal glucose concentration or reduced the number of low glucose levels or the number of patients with low levels. Terbutaline raised the mean nadir nocturnal glucose concentration (mean ± se, 127 ± 11 vs. 75 ± 9 mg/dl; P < 0.001), eliminated glucose levels less than 50 mg/dl (P = 0.038), reduced levels less than 60 mg/dl (P = 0.005) to one, and reduced levels less than 70 mg/dl (P = 0.001) to five (four at 2215 h, one at 2230 h). However, it also raised glucose levels the following morning. Conclusions: Nocturnal hypoglycemia is common in aggressively treated type 1 diabetes. Bedtime administration of a conventional snack or of uncooked cornstarch does not prevent it. That of terbutaline prevents nocturnal hypoglycemia but causes hyperglycemia the following morning. The efficacy of a lower dose of terbutaline remains to be determined. Background: GH deficiency (GHD) acquir Continue reading >>

A Case Of Recurrent Hypoglycemia In A Patient With Type 1 Diabetes: When The Obvious Is Not So Obvious!

A Case Of Recurrent Hypoglycemia In A Patient With Type 1 Diabetes: When The Obvious Is Not So Obvious!

A case of recurrent hypoglycemia in a patient with type 1 diabetes: when the obvious is not so obvious! Ruchir Trivedi, Gautam Das, Joanne Cutler & Parijat De Diabetes & Endocrine Unit, City Hospital, Birmingham, United Kingdom. Hypoglycemia is not uncommonly encountered in healthy type 1 diabetics. It has diverse etiologies but food-insulin mismatch, exercise, drugs, co-existing adrenal, thyroid and coeliac disease, neuro-endocrine tumours & factitious hypoglycemia are the most common causes. We describe the case of a 23-year old Caucasian male with type 1diabetes of 3-years duration with recurrent episodes of unexplained hypoglycemia. He was otherwise well and denied any systemic symptoms apart from weight loss in the last 18 months. He was a non-smoker and non-alcoholic. He had diabetic neuropathy but no nephropathy or retinopathy. He was injecting insulin Lispro (three times daily) and insulin Glargine at bed time but had poor glycemic control (HbA1c 9.1%). He was admitted for further investigations to get to the bottom of his recurrent hypoglycaemic spells. Routine blood tests and biochemistry was normal. He was not acidotic and urinanalysis showed presence of ++ glucose and trace ketones. Short synacthen test and coeliac screen was normal. Pituitary hormone profile and IGF 2 & 3 were also normal. Toxicology and sulphonylurea screen were negative. US and CT abdomen was unremarkable. He underwent a supervised prolonged fast in the hospital but had two episodes of hypoglycemia (BMs 1.2 mmol and 1.6 mmol) within the first 8 hours needing treatment. Insulin levels were found 4 times in excess of normal with negligible levels of C peptide confirming factitious hypoglycaemia from surreptitious insulin use. On direct confrontation, he admitted self-injecting insulin and Continue reading >>

Fear Of Hypoglycemia In Adults With Type 1 Diabetes: Impact Of Therapeutic Advances And Strategies For Prevention - A Review

Fear Of Hypoglycemia In Adults With Type 1 Diabetes: Impact Of Therapeutic Advances And Strategies For Prevention - A Review

Volume 30, Issue 1 , JanuaryFebruary 2016, Pages 167-177 Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention - a review Author links open overlay panel PamelaMartyn-Nemetha This review summarizes the current state of the science related to fear of hypoglycemia (FOH) in adults with type 1 diabetes. Fear of hypoglycemia is a critical deterrent to diabetes self-management, psychological well-being, and quality of life. We examine the influence of contemporary treatment regimens, technology, and interventions to identify gaps in knowledge and opportunities for research and practice. A literature search was conducted of MEDLINE, PsycINFO, and EMBASE. Fifty-three studies that examined fear of hypoglycemia were included. Fear of hypoglycemia influences diabetes management and quality of life. Gender and age differences exist in experiences and responses. Responses vary from increased vigilance to potentially immobilizing distress. Fear of hypoglycemia is greater at night and may contribute to poor sleep quality. Strategies to reduce fear of hypoglycemia have had varying success. Newer technologies hold promise but require further examination. Fear of hypoglycemia remains a problem, despite advances in technology, insulin analogs, and evidence-based diabetes management. Clinical care should consistently include assessment for its influence on diabetes self-management and psychological health. Further research is needed regarding the influence of newer technologies and individualized strategies to reduce fear of hypoglycemia while maintaining optimal glucose control. Continue reading >>

Episodes Of Severe Hypoglycemia In Type 1 Diabetes Are Preceded And Followed Within 48 Hours By Measurable Disturbances In Blood Glucose

Episodes Of Severe Hypoglycemia In Type 1 Diabetes Are Preceded And Followed Within 48 Hours By Measurable Disturbances In Blood Glucose

This study quantifies blood glucose (BG) disturbances occurring before and after episodes of severe hypoglycemia (SH). For 68 months, 85 individuals with type 1 diabetes and a history of SH (age, 44 10 yr; 41 women and 44 men; duration of diabetes, 26 11 yr; hemoglobin A1c, 7.7 1.1%) used Lifescan One Touch BG meters for self-monitoring three to five times daily and recorded the date and time of SH episodes in diaries. For each subject, the timing of SH episodes was located in the temporal stream of SMBG readings recorded by the meter, and characteristics, including the Low BG index (LBGI), were computed in 24-h increments. In the 24-h period before the SH episode LBGI rose (P < 0.001), average BG was lower (P = 0.001), and BG variance increased (P = 0.001). In the 24 h after SH, LBGI and BG variance remained elevated (P < 0.001), but average BG returned to baseline. These disturbances disappeared in 48 h. On the basis of LBGI we identified subjects at low, moderate, and high risk of SH, who reported, on the average, 1.7, 3.4, and 7.4 SH episodes (P < 0.005) during the study. In addition, we designed an algorithm that predicted 50% of all SH episodes that occurred in this subject group. We conclude that episodes of SH are preceded and followed by quantifiable BG disturbances, which could be used to devise warnings of imminent SH. EXTENSIVE STUDIES, including the Diabetes Control and Complications Trial (DCCT) ( 1 ), the Stockholm Diabetes Intervention Study ( 2 ), and the United Kingdom Prospective Diabetes Study ( 3 ), have repeatedly demonstrated that the maintenance of blood glucose (BG) levels approximating the normal range reduces long-term complications of diabetes. However, the same studies also documented adverse effects of intensive insulin therapy, the most a Continue reading >>

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