Hypoglycemia in the treated diabetic patient. A risk of intensive insulin therapy

With more physiologic insulin replacement and more accurate glucose monitoring, it was believed that very strict glycemic control of IDDM could be achieved without increasing the risks of hypoglycemia. No one anticipated that intensive treatment itself would lead to physiologic adaptations that would impair protective responses and contribute to the two- to threefold increase in risk of hypoglycemia. The influence of diabetes and its control on the recognition of and response to hypoglycemia are explored in this section as well as steps that can be taken by the patient and clinician to reduce these risks.