Hypoglycemia is the limiting factor in the management of diabetes

Hypoglycemia is the limiting factor, both conceptually and in practice, in the management of diabetes mellitus. While the long‐term goal of diabetes research must remain the cure and the prevention of the disease and reasonable near‐term goals might include perfect insulin replacement or prevention of complications despite ongoing hyperglycemia, the most pressing short‐term goal for people with diabetes would seem to be insight leading to strategies that effectively minimize the risk of hypoglycemia and thus permit low‐risk glycemic control. Having reviewed the field in detail recently, the author offers his personal views of the key questions – concerning the physiology of glucose counterregulation, its pathophysiology in diabetes, and hypoglycemia in diabetes – that, if answered, might lead to a reduced risk of iatrogenic hypoglycemia in people with diabetes. The overriding question is: How can we learn to replace insulin more perfectly, prevent, correct or compensate for compromised glucose counterregulation, or both? Copyright © 1999 John Wiley & Sons, Ltd.

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