Hypoglycemia in Diabetes Diabetes Care 26:1902-1912, 2005 Diabetes Care 28:1245-1249, 2005 Philip E Cryer MD.

1. Hypoglycemia in Diabetes Diabetes Care 26:1902-1912, 2005Diabetes Care 28:1245-1249, 2005Philip E Cryer MD. Chien-Wen Chou MD.Chi-Mei Medical Center 2 Sep 2005

2. Frequency of Iatrogenic Hypoglycemia (1) Type 1 diabetes episodes of asymptomatic hypoglycemia; plasma glucose levels may be less than 50–60 mg/dl (2.8–3.3 mmol/l) 10% of the time They suffer an average of two episodes of symptomatic hypoglycemia per week —thousands of such episodes over a lifetime of diabetes an episode of severe hypoglycemia approximately once a year An estimated 2–4% of deaths of people with type 1 diabetes have been attributed to hypoglycemia

3. Frequency of Iatrogenic Hypoglycemia (2) Type 2 diabetes event rates for severe hypoglycemia during aggressive insulin therapy in type 1 diabetes range from 62 through 110 to 170 episodes per 100 patient-years. Those during aggressive insulin therapy in type 2 diabetes range from 3 through 10 to 73 episodes per 100 patient-years. the rates of severe hypoglycemia in type 2 diabetes are roughly 10% of those in type 1 diabetes even during aggressive therapy with insulin. Over 6 years of follow-up of patients with type 2 diabetes in UKPDS, 2.4% of those using metformin, 3.3% of those using a sulfonylurea, and 11.2% of those using insulin reported major hypoglycemia (that requiring medical attention or admission to hospital) For comparison, 65% of the intensively treated patients with type 1 diabetes in the DCCT suffered severe hypoglycemia (that requiring the assistance of another individual) over 6.5 years of follow-up

4. Physiology of Glucose Counterregulation (1) Glycemic thresholds Decreased insulin secretion as glucose concentrations decline within the physiological range. The physiological postabsorptive plasma glucose concentration range is 72–108 mg/dl (4.0–6.0 mmol/l). The mean arterialized venous glycemic threshold for a decrease in insulin is 81 mg/dl (4.5 mmol/l).  Increased glucagon and epinephrine secretion, among other neuroendocrine responses, as glucose concentrations fall just below the physiological range. The glycemic threshold is 65–70 mg/dl (3.6–3.9 mmol/l).  Neurogenic and neuroglycopenic symptoms, and cognitive impairments, at lower plasma glucose concentrations. The glycemic threshold for symptoms is 50–55 mg/dl (2.8–3.0 mmol/l).