Hypoglycaemia, which occurs when blood levels of glucose fall below what is considered a normal range, is a well-known complication of insulin therapy in individuals with type 1 diabetes mellitus. Despite advances in diabetes mellitus management, hypoglycaemia has continued to affect the majority of these individuals, leading to suboptimal care and decreased quality of life. Multiple epidemiological studies have demonstrated the risks associated with hypoglycaemic events. With this understanding, various advances have been made in therapeutics for diabetes mellitus management. Diabetes mellitus education continues to form the foundation for management and prevention of hypoglycaemia. The advent of newer diabetes mellitus technologies and newer insulins herald improvements in management strategies and hypoglycaemia prevention. Improved understanding of these newer approaches is needed to ensure delivery of safe and effective care to individuals with type 1 diabetes mellitus, leading to reductions in both the short-term and long-term morbidity and mortality associated with hypoglycaemic events.
Hypoglycaemia is a common occurrence in people with type 1 diabetes mellitus, and can have serious consequences. This Review defines hypoglycaemia in type 1 diabetes mellitus, and also outlines its frequency, risk factors and adverse outcomes. Ways to prevent and treat this complication of insulin therapy are also discussed.
Key points: Most individuals with type 1 diabetes mellitus (T1DM) experience frequent hypoglycaemic events.Long-term risks of hypoglycaemia include impaired awareness of hypoglycaemia, cognitive decline, increased cardiovascular events and increased mortality.Diabetes mellitus self-management education is an important resource that should be provided to all individuals with T1DM to prevent hypoglycaemia and optimize glycaemic control.Use of continuous glucose monitors and hybrid closed loop insulin pumps can lead to reductions in hypoglycaemia and improved glycaemic control.Substituting newer insulins (without peak effects and with longer half-lives) for older basal insulins should be considered to reduce hypoglycaemia.