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 .
Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM
Summary In patients with insulin-dependent diabetes mellitus ( IDDM ) good glycaemic control confers an enhanced risk of hypoglycaemia . Nocturnal hypoglycaemia occurs frequently and contributes to the syndrome of hypoglycaemia unawareness . In order to avoid nocturnal hypoglycaemia we substituted night-time continuous subcutaneous insulin infusion ( CSII ) therapy in 14 patients with well-controlled IDDM using a multiple injection regimen for the more variable bedtime NPH insulin . During a stepwise hypoglycaemic clamp we studied the effect of this regimen on counterregulatory hormonal responses , warning symptoms and cognitive function . In addition , we investigated the incidence of daytime hypoglycaemia and the acceptability of night-time CSII  treatment . CSII was associated with a lower frequency of hypoglycaemia ( mean ± SEM ) : 16.1 ± 3.1 vs 23.6 ± 3.3 ) episodes during the last 6 weeks of treatment , p = 0.03 ( CSII vs NPH ) ) with maintenance of good glycaemic control ( HbA1c 7.2 ± 0.2 vs 7.1 ± 0.2 % , p = 0.2 ) . Hypoglycaemic thresholds for the growth hormone response and for autonomic symptoms were lower for CSII treatment than for NPH treatment . Of 14 patients 6 decided to continue with the nocturnal CSII treatment . In conclusion , nocturnal CSII improves warning symptoms and counterregulatory hormonal responses to hypoglycaemia and is an acceptable treatment strategy for patients suffering from hypoglycaemia unawareness , as demonstrated in this acute feasibility study . [ Diabetologia ( 1998 ) 41 : 322–329
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 .