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 .
Blood glucose estimation and symptoms during hyperglycemia and hypoglycemia in patients with insulin-dependent diabetes mellitus.
PURPOSE To investigate hypoglycemic and hyperglycemic symptoms , accuracy of estimating blood glucose , and their relation to glycemic control and counterregulatory hormone levels in insulin-dependent diabetes mellitus . PATIENTS AND METHODS During r and omly ordered stepped hypoglycemic and hyperglycemic insulin clamps on two separate days , 42 patients with insulin-dependent diabetes mellitus rated the intensity of 40 moods and symptoms when glucose was 8.9 , 5.6 and 2.2 mmol/L , and 8.9 , 14.4 and 21.1 mmol/L. The subjects were blinded to their actual glucose levels and asked to estimate them at each step . Epinephrine , norepinephrine , cortisol , growth hormone , and glucagon were measured at each glucose plateau . RESULTS Cluster analysis yielded five symptom groups during hypoglycemia : autonomic symptoms , negative moods , positive moods , feeling weak/dizzy , and feeling relaxed . At 2.2 mmol/L , mean scores for all five symptom groups and 11 of 17 unclustered symptoms differed from those reported at the baseline glucose of 8.9 mmol/L ( P < or = 0.05 ) , but 34 % of patients reported no awareness of autonomic symptoms . The intensity of autonomic symptoms correlated positively with HbA1 ( r = .43 , P < 0.01 ) , epinephrine ( r = .59 , P < 0.001 ) , norepinephrine ( r = .45 , P < 0.01 ) and cortisol ( r = .62 , P < 0.001 ) , and negatively with glucose estimation error ( r = -.45 , P = 0.01 ) . Six patients ( 15 % ) were unaware of both autonomic and neuroglycopenic symptoms during hypoglycemia . At 21.1 mmol/L , only 5 of 40 symptoms differed ( P < 0.05 ) from baseline . Seventeen percent of subjects made potentially serious errors when estimating glucose at 2.2 mmol/L , and 66 % at 21.1 mmol/L. Many patients experienced symptoms different from those they reported as their usual manifestations of changing glucose levels . CONCLUSIONS Since the majority of patients made clinical ly serious errors in glucose estimation , and many used symptoms that did not discriminate hyperglycemia and hypoglycemia , individualized training to increase awareness of glucose-related symptoms and glucose levels may help patients reduce the frequency or severity of hyperglycemic and hypoglycemic events
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 .