Hypoglycemia is the limiting factor in the management of diabetes

Diabetes Metab Res Rev. Jan-Feb 1999;15(1):42-6. doi: 10.1002/(sici)1520-7560(199901/02)15:1<42::aid-dmrr1>3.0.co;2-b.


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?

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Blood Glucose / metabolism
  • Diabetes Complications
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / physiopathology
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / complications*
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Insulin / adverse effects


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin