Murata et al evaluated Type 2 diabetics who were treated with insulin and who showed a lack of hypoglycemia awareness. These can help identify a group of patients who may benefit from more aggressive management. The authors are from several Veterans Affairs hospitals in New Mexico.


Risk factors for poor hypoglycemia awareness:

(1) age > 60 years

(2) no or little knowledge about diabetes

(3) low hemoglobin A1c

(4) absence of microvascular complications



• A patient with high hemoglobin A1c or microvascular complications would be someone more likely to have problems associated with poor glucose control at the high end.


Additional risk factors for failure to detect hypoglycemia:

(1) beta-blocker therapy (may mask the autonomic symptoms of hypoglycemia)

(2) multiple previous episodes of hypoglycemia unawareness


Risk factors for developing hypoglycemia:

(1) tight diabetic control

(2) infrequent glucose monitoring

(3) concurrent disease that lowers blood glucose (alcohol abuse, liver disease, advanced renal failure, etc)

(4) previous history of hypoglycemia


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