These were able to reduce SH and improve glycemic control , with greater benefit from the latter two techniques in improving IAH .
Technological interventions ( insulin pump therapy , continuous glucose monitoring , and sensor-augmented pump ) reduced SH , improved glycemic control , and restored awareness when used in combination with structured education and frequent contact .
This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH  , initially with structured diabetes education in flexible insulin therapy , which may incorporate psychotherapeutic and behavioral therapies , progressing to diabetes technology , incorporating sensors and insulin pumps , in those with persisting need
OBJECTIVE Impaired awareness of hypoglycemia ( IAH ) increases the risk of severe hypoglycemia ( SH ) sixfold and affects 30 % of adults with type 1 diabetes ( T1D ) .
This systematic review and meta- analysis looks at the educational , technological , and pharmacological interventions aim ed at restoring hypoglycemia awareness ( HA ) in adults with T1D .
Recovery of epinephrine response but not hypoglycemic symptom threshold after intensive therapy in type 1 diabetes.
PURPOSE Patients with intensively treated insulin-dependent diabetes mellitus ( IDDM ) exhibit more severe defects in counterregulatory hormone secretion and symptom recognition during hypoglycemia than do conventionally treated patients . In this prospect i ve study in patients with preexisting defects in counterregulation , we examined the induction and reversibility of impaired symptomatic and adrenomedullary responses to hypoglycemia in 5 patients with IDDM ( diabetes duration of 2 to 16 years ; aged 19 to 36 years ; 3 women , 2 men ) who were receiving intensive therapy .  METHODS Counterregulatory responses were assessed by using a single-step ( approximately 2.8 mmol/L plasma glucose ) and multiple-step ( from approximately 5 mmol/L to 2.2 mmol/L plasma glucose ) clamped hypoglycemia procedure . Patients were first studied after a stable period of conventional insulin therapy ( glycosylated hemoglobin [ HbA1c ] 9.5 + /- 1.2 % ) , then after 3 to 5 months of intensive therapy ( HbA1c 6.6 + /- 0.2 % ) , and a third time after resuming conventional therapy ( HbA1c 8.7 + /- 0.9 % ) . RESULTS Intensive therapy was associated with a 44 % decline ( P < 0.01 ) in the average plasma epinephrine increase during hypoglycemia , and the plasma glucose level required to stimulate epinephrine secretion fell from 3.7 + /- 0.2 to 3.0 + /- 0.1 mmol/L ( P < 0.01 ) . The threshold , but not the magnitude , of the plasma norepinephrine response was similarly altered . Hypoglycemic symptoms also decreased in intensity ( by 67 % , P < 0.01 ) , and the glucose level required for symptom activation fell from 3.4 + /- 0.3 to 2.7 + /- 0.2 mmol/L , P < 0.01 ) . When conventional therapy was resumed , the abnormalities in the epinephrine response due to intensive therapy were almost completely reversed . However , the reduction in symptoms and the altered thresholds for plasma norepinephrine were not reversed . CONCLUSIONS There is dissociation between the treatment-associated defects in hypoglycemia counterregulation in IDDM , and an increase in average glycemia produced by a return to conventional insulin therapy is not sufficient to reverse hypoglycemia unawareness worsened by intensive therapy
These were able to reduce SH and improve glycemic control , with greater benefit from the latter two techniques in improving IAH .
Technological interventions ( insulin pump therapy , continuous glucose monitoring , and sensor-augmented pump ) reduced SH , improved glycemic control , and restored awareness when used in combination with structured education and frequent contact .
This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH  , initially with structured diabetes education in flexible insulin therapy , which may incorporate psychotherapeutic and behavioral therapies , progressing to diabetes technology , incorporating sensors and insulin pumps , in those with persisting need
OBJECTIVE Impaired awareness of hypoglycemia ( IAH ) increases the risk of severe hypoglycemia ( SH ) sixfold and affects 30 % of adults with type 1 diabetes ( T1D ) .
This systematic review and meta- analysis looks at the educational , technological , and pharmacological interventions aim ed at restoring hypoglycemia awareness ( HA ) in adults with T1D .