Hypoglycemia in insulin-treated diabetes: a case for increased vigilance

Studies have shown that effective diabetes management can delay or prevent the micro- and macrovascular complications of diabetes. Achieving optimal glycemic control often requires treatment with intensive insulin management. However, with intensive insulin management comes the risk of severe hypoglycemia. Hypoglycemia requiring emergency medical assistance is as common in patients with longstanding insulin-treated type 2 diabetes mellitus as in patients with type 1 diabetes mellitus, and is associated with a significant economic and personal burden; untreated, severe hypoglycemia can result in morbidity and death. Key contributors to severe hypoglycemia are asymptomatic hypoglycemia and nocturnal hypoglycemia; both conditions inhibit patients' ability to recognize hypoglycemia when it is occurring and take appropriate action. As a result, many patients with types 1 and 2 diabetes mellitus are reluctant to follow and/or adjust their insulin regimens as needed because of fear of hypoglycemia, resulting in exposure to chronic hyperglycemia, oxidative stress, and long-term complications. Severe hypoglycemia can be prevented through vigilance in identifying patients at risk, utilizing appropriate medications and medication regimens, and effective glucose monitoring strategies and technologies. The purpose of this article is to review our current understanding of hypoglycemia and its impact on diabetes management, and to provide guidance to health care providers when assisting patients who utilize insulin therapy to do so safely and effectively.