Insulin Therapy and Hypoglycemia in Type 2 Diabetes Mellitus

Philip E. Cryer, MD

INTRODUCTION

Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes mellitus (DM).¹ It causes recurrent morbidity in most people with type 1 DM and many with advanced type 2 DM, and is sometimes fatal. Furthermore, the barrier of hypoglycemia precludes maintenance of euglycemia over a lifetime of DM and thus full realization of the long-term benefits of glycemic control. Finally, even asymptomatic episodes of hypoglycemia, as well as prior exercise and sleep, further compromise defenses against subsequent falling plasma glucose concentrations and thus cause a vicious cycle of recurrent hypoglycemia. Despite steady advances in the glycemic management of DM, the problem of hypoglycemia has not been solved.