Diverse Causes of Hypoglycemia-Associated Autonomic Failure in Diabetes

Abstract

This review explains our current understanding of the syndromes of defective glucose counterregulation and hypoglycemia unawareness in persons with diabetes. The physiologic defenses against hypoglycemia — the glucagon and epinephrine responses — are compromised in most people with type 1 diabetes and in many with advanced type 2 diabetes. In addition to hypoglycemia, exercise and sleep are causes of autonomic failure that must be recognized and require changes in the management of diabetes.