Management of acute and recurrent hypoglycaemia

Hypoglycaemia is a frequent adverse effect of insulin and sulfonylurea therapy for diabetes. Hypoglycaemia develops as a consequence of the limitations of current therapies and their delivery systems and because most individuals with insulin and/or sulfonylurea-treated diabetes develop widespread defects in their counterregulatory defence responses against low glucose. The initial focus of this chapter is discussion of factors or co-morbidities that may increase hypoglycaemia risk. Subsequently, the approaches used to identify the pattern of hypoglycaemia in any one individual are examined, including use of the new continuous glucose monitoring systems. Guidelines for the management of both acute and recurrent hypoglycaemia are then assessed and the evidence is reviewed in favour of any given approach. Structured educational programmes, insulin analogues, insulin pump therapy, continuous glucose monitoring, the artificial pancreas as well as more novel approaches are reviewed. At present, there is no clear support for any one approach to management and treatments have to be tailored to the individual.