HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rossetti, P. Articles by Fanelli, C. G. Search for Related Content PubMed PubMed Citation Articles by Rossetti, P. Articles by Fanelli, C. G. Social Bookmarking                What's this?

Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes

The role of insulin analogs

From the Department of Internal Medicine, Section of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Perugia, Italy

Address correspondence and reprint requests to Prof. Geremia B. Bolli, University of Perugia, Department of Internal Medicine, Section of Internal Medicine, Endocrinology and Metabolism, Via E. Dal Pozzo, 6126 Perugia, Italy. E-mail: gbolli@unipg.it

Abbreviations: CSII, continuous subcutaneous insulin infusion • MDI, multiple daily injections

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Insulin therapy in diabetes, both at onset and after several years’ duration, is primarily directed to maintain near-normoglycemia to prevent the onset and/or delay progression of long-term complications (1,2). However, it is important that regimens of insulin therapy are designed not only to aim at near-normalizing blood glucose, but also to minimize the risk of hypoglycemia. Subjects with type 1 diabetes continuously drift between hyperglycemia and hypoglycemia. If the former prevails, long-term complications are frequently expected (1). On the other hand, hypoglycemia is not only dangerous and unpleasant, but may over time lead to the syndrome of hypoglycemia unawareness (3).

This is relevant in type 1 diabetes but also in type 2 diabetes, since over time, many type 2 diabetic subjects develop progressive pancreatic β-cell dysfunction requiring insulin therapy. Because in subjects with advanced type 2 diabetes the neuroendocrine responses to hypoglycemia are as abnormal as in type 1 diabetic patients (4), insulin therapy may become responsible for frequent and/or severe hypoglycemia in type 2 diabetic patients as well.

The goal of minimizing the risk of hypoglycemia while achieving good glycemic control is feasible as long as 1) a rational plan of insulin therapy is adopted, 2) blood glucose is properly monitored, 3) blood glucose targets are individualized, and 4) education programs are widely implemented.

In the present article, the importance of the use of insulin analogs as a key tool to achieve good glycemic control and prevent hypoglycemia is emphasized.

	PHYSIOLOGY OF PLASMA GLUCOSE HOMEOSTASIS

 
Normal nondiabetic subjects maintain plasma glucose <100 mg/dl in the fasting and <135 mg/dl in the postprandial period. In the fasting state, this is due to the continuous release of insulin from the pancreas, which results in steady plasma insulin, thus restraining hepatic glucose production . . . [Full Text of this Article]

	DEFINITION OF HYPOGLYCEMIA

 

	FREQUENCY OF HYPOGLYCEMIA

 

	NORMAL RESPONSES TO HYPOGLYCEMIA AND THEIR PATHOPHYSIOLOGY IN DIABETES

 

	ANTECEDENT HYPOGLYCEMIA AS A PRIMARY CAUSE OF HYPOGLYCEMIA UNAWARENESS IN DIABETES

 
Mechanisms of hypoglycemia unawareness

	THE VICIOUS CIRCLE OF RECURRENT HYPOGLYCEMIA UNAWARENESS

 

	BENEFITS OF INSULIN ANALOGS VERSUS HUMAN NONMODIFIED INSULIN

 
Rapid-acting insulin analogs
Long-acting insulin analogs

	REGIMENS OF MULTIPLE DAILY INJECTIONS AND CSII

 

	CONCLUSIONS

 

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?