SN, Shamoon H: Hypoglycemia in diabetes

Glycemic control, a worthwhile goal for peoplewith diabetes, is limited by the barrier of iatro-genic hypoglycemia (1). Iatrogenic hypoglyce-mia 1) causes recurrent morbidity in most people with type 1 diabetes and many with advanced type 2 diabetes and is sometimes fatal, 2) compromises physi-ological and behavioral defenses against subsequent fall-ing plasma glucose concentrations and thus causes a vicious cycle of recurrent hypoglycemia, and 3) precludes maintenance of euglycemia over a lifetime of diabetes and therefore full realization of the vascular benefits of glyce-mic control. The premise of this “Perspective in Diabetes” is that insight into the pathophysiology of glucose coun-terregulation in diabetes leads to understanding of the frequency and impact of, risk factors for, and prevention of iatrogenic hypoglycemia. Partial glycemic control reduces, but does not eliminate, the development of microvascular complications of diabe