Spotlight Article

Therapeutic strategies to prevent hypoglycemia using pharmacologic interventions

Priya S George and Rory J McCrimmon

Diabetic Hypoglycemia October 2012, Volume 5, Issue 2: page 13-16

Abstract

On average, a person with type 1 diabetes has at least two symptomatic hypoglycemia episodes per week and therefore, hypoglycemia poses a significant psychologic and pathologic barrier to achieving optimal glucose control. Recurrent hypoglycemia can diminish the symptomatic, hormonal and cognitive responses during further hypoglycemia, by causing the normal glycemic thresholds for these responses to hypoglycemia to be shifted to lower glucose levels and so leading to impaired hypoglycemia awareness (IHA). Intact awareness is crucial to both recognizing and treating hypoglycemia before it becomes sufficiently severe to affect cognition and threaten consciousness.

One of the main strategies for improving this response clinically is through strict avoidance of hypoglycemia. The pharmacologic approaches that may improve counter-regulatory responses and symptomatic responses are reviewed, through modulation of the responses either by addressing α cell defects in the pancreas or by approaching central defects of counter-regulation and the various glucose-sensing mechanisms that operate during hypoglycemia.

Keywords: type 1 diabetes, hypoglycemia, impaired hypoglycemia awareness, counter-regulatory responses