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 .
Propranolol in hypoglycaemia unawareness.
The effect of propranolol on the occurrence of hypoglycaemic symptoms was assessed in insulin-dependent diabetic patients with hypoglycaemia unawareness . A double-blind , r and omised parallel group study ( 2:1 fashion ) was conducted over 4-week period . The propranolol group ( n = 9 ) received 20 mg ( week 1 and 2 ) and 30 mg ( week 3 and 4 ) twice daily , and the other group ( n = 5 ) a matched placebo for 4 weeks . Patients included had experienced at least two severe hypoglycaemic episodes ( coma or seizures ) during the previous year , which were characterised by a lack of adrenergic symptoms and required the assistance of another person . The mean number of hypoglycaemias during the study period was similar in both groups ( placebo : 13 + /- 2 propranolol : 11 + /- 1 ) , whereas the number of totally asymptomatic hypoglycaemias ( < 0.6 g/l ) was lower on propranolol than on placebo ( 3 + /- 1 vs 8 + /- 3 , NS ) and the number of symptomatic hypoglycaemias was higher ( 7.2 + /- 2 vs 4.6 + /- 1 , NS ) . Subjective evaluation of treatment by the investigators showed 0/5 successes in the placebo group and 5/9 in the propranolol group ( chi2 = 4.32 , p = 0.038 ) . The main advantage of propranolol over placebo was an increased incidence of sweating . The ratio [ number of hypoglycaemias with sweating/total number of hypoglycaemias ] being higher with propranolol ( 0.28 + /- 0.08 vs 0.06 + /- 0.02 , p = 0.06 ) . This pilot study suggests that beta-blockers may be useful in restoring adrenergic symptoms during hypoglycaemia in insulin-dependent diabetic patients without warning symptoms of hypoglycaemia . This beneficial effect seems to be predominantly related to an increase in hypoglycaemia-induced sweating . A larger study is needed to confirm or invali date these preliminary results
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 .