Hypoglykämien: Ein ernstzunehmendes Problem in der Diabetesbehandlung

Hypoglycaemia: A Serious Prob- lem in the Management of Diabetes. In the 2001 Claude Bernard Lecture of the European Association for the Study of Diabetes, Philip Cryer named hypoglycaemia "the limiting fac- tor in the glycaemic management of type-1 and type-2 diabetes". Hypoglycaemia affects all people managing their diabetes with insu- lin or insulinotropic oral medications. Many experience hypoglycaemia as one of the major burdens of diabetes treatment. Many diabetic patients develop problems with hypoglycaemia over time, e. g., worsening of hypoglycaemia awareness or the occurrence of severe hypogly- caemia which requires third-party assistance. The development of hypoglycaemia problems is directly associated with the treatment goal of normoglycaemia. In diabetic patients with a near-normoglycaemic control and frequently low blood glucose levels counterregulatory hormonal responses decline over time. These defi cien- cies are the physiological base of the concepts of hypoglycaemia-associated autonomic failure and hypoglycaemia unawareness. This review describes the relevance of hypoglycaemia prob- lems in the treatment of people with diabetes, increases the understanding of the pathophysio- logical concept of hypoglycaemia unawareness, and shows options for an effective treatment with the focus on type-1 diabetes. J Klin En- dokrinol Stoffw 2011; 4 (3): 18-24.