Hypoglycaemia Unawareness : Practical Avoidance and Management : Review

ABSTRACT

In diabetic patients requiring insulin; hypoglycaemic events are inevitable and severe hypoglycaemia is one of the most feared complications of the disease. It is associated with not only physical discomfort; cognitive dysfunction and loss of personal control; but sometimes more severe consequences; including coma and death. In comparison with conventional glucose targets; iatrogenic hypoglycaemia is up to six times more common with intensive therapy and remains the most important barrier to sustained good glucose control. Neural tissue is dependent on a continuous supply of glucose for maintenance of function. Consequently; the development of symptoms in response to low glucose levels is essential for recognising impending neuroglycopenia and to provoke timeous corrective measures to restore glucose balance. Unawareness of hypoglycaemia and failure to develop warning symptoms therefore increases the risk of severe hypoglycaemia and its associated morbidity