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 .
Optimized basal-bolus therapy using a fixed mixture of 75% lispro and 25% NPL insulin in type 1 diabetes patients: no favorable effects on glycemic control, physiological responses to hypoglycemia, well-being, or treatment satisfaction.
OBJECTIVE To investigate the effects of a multiple injection regimen with a mixture of 75 % lispro and 25 % intermediate-acting insulin ( lispro high mixture [ HM ] ) before meals on glycemic control , physiological responses to hypoglycemia , well-being , and treatment satisfaction . RESEARCH DESIGN AND METHODS We studied 35 type 1 diabetes patients . After an 8- to 10-week lead-in period , patients were r and omized to HM or human regular insulin therapy for 12 - 14 weeks . During the lead-in and treatment periods , HbA1c levels and hypoglycemic frequencies were measured , and patients completed the Well-Being Question naire and the Diabetes Treatment Satisfaction Question naire . In 19 patients , responses to hypoglycemia were tested during stepped euglycemic-hypoglycemic clamps . RESULTS HM treatment improved postpr and ial glycemia but had no effect on HbA1c , frequency of hypoglycemia , well-being , or treatment satisfaction . During experimental hypoglycemia , HM therapy was associated with a slightly lower total adrenaline response and a higher autonomic symptom threshold ( i.e. , the autonomic symptom response occurred at a lower blood glucose level ) than human regular insulin therapy . We speculate that this effect result ed from an accumulation of insulin during the night . CONCLUSIONS Multiple injection therapy with HM rather than human regular insulin before meals does not offer advantages regarding glycemic control , frequency of hypoglycemia , well-being , or treatment satisfaction . In addition , this regimen causes an attenuation of the adrenaline and autonomic symptom responses to hypoglycemia
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 .