Hypoglycemia: The Limiting Factor in the Management of Insulin-Dependent Diabetes Mellitus

For persons with IDDM, hypogly cemia is an ever-present possi bility. Untreated, it can be life threatening. Based on the assumption that metabolic normalization will prevent long- term complications, many health professionals advocate tight glycemic control of IDDM. However, with today's technology, true metabolic normalization is an illusion. Practitioners need to develop ways to deliver insulin in a more physiologic fashion or learn to prevent, correct, or compensate for defective glucose counterregulation. They also need simpler methods for identifying patients at high risk for hypogly cemia. Patients need to learn how to recognize developing hypogly cemia from symptoms specific to them, how to treat it when it occurs, and how to prevent future episodes. Diabetes educators need to know how to effectively transfer the known body of knowledge about hypoglycemia to the patient with IDDM, since that is the individual charged with primary responsibility for the management of the disease.