Impaired hypoglycaemia awareness in type 1 diabetes: Lessons from the lab
Open accessAbstract
Hypoglycaemia remains the most common metabolic adverse effect of insulin and sulfonylurea therapy in diabetes. Repeated exposure to hypoglycaemia leads to a change in the symptom complex that characterises hypoglycaemia, culminating in a clinical phenomenon referred to as impaired awareness of hypoglycaemia (IAH). IAH effects approximately 20-25% of people with type 1 diabetes and increases the risk of severe hypoglycaemia. This review focuses on the mechanisms that are responsible for the much higher frequency of hypoglycaemia in people with diabetes compared with those without, and subsequently how repeated exposure to hypoglycaemia leads to the development of IAH. The mechanisms that result in IAH development are incompletely understood and likely to reflect changes in multiple aspects of the counterregulatory response to hypoglycaemia, from adaptations within glucose and non-glucose-sensing cells to changes in the integrative networks that govern glucose homeostasis. Finally, we propose that the general process that incorporates many of these changes and results in IAH following recurrent hypoglycaemia is a form of adaptive memory called 'habituation'.
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Hormonal dysregulation has been identified as a significant factor contributing to the development of hypoglycemia unawareness syndrome.
“Hormonal dysregulation has been identified as a significant factor contributing to the development of hypoglycemia unawareness syndrome.”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [23]
In individuals with T1D or prolonged type 2 diabetes (T2D), unregulated insulin release from subcutaneous depots or the sustained effects of sulfonylureas can result in elevated systemic insulin levels during hypoglycemia.
“In individuals with T1D or prolonged type 2 diabetes (T2D), unregulated insulin release from subcutaneous depots or the sustained effects of sulfonylureas can result in elevated systemic insulin levels during hypoglycemia.”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [23]
There is a paradoxical impairment of glucagon secretion during hypoglycemia in patients with diabetes.
“Furthermore, there is a paradoxical impairment of glucagon secretion during hypoglycemia in patients with diabetes.”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [23]
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“Habituation is a form of adaptive learning and is usually seen in the context of innate behaviours, presenting as a reduced response to repeated external or internal stimuli [45, 46].”
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- Authors
- McNeilly, A. D., & McCrimmon, R. J.
- Affiliations
- University of Dundee (GB)
- Corresponding author
- McCrimmon, Rory J.
- Venue
- Diabetologia
- Published
- 2018-02-07
- Volume
- 61
- Issue
- 4
- Pages
- 743-750
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6448989
- OpenAlex
- W2792158727
- Cited by
- 55
- References
- 51
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 11 · 2023: 8 · 2022: 7 · 2021: 9 · 2020: 7 · 2019: 1 · 2018: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by)
- Funders
- University of Dundee
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- impaired awareness of hypoglycaemia, type 1 diabetes, hypoglycemia, counterregulatory response, glucose homeostasis, insulin therapy, sulfonylurea therapy, habituation, adaptive memory, glucose detection
- MeSH terms
- Animals, Awareness, Diabetes Mellitus, Type 1, Disease Models, Animal, Glucose, Habituation, Psychophysiologic, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Surveys and Questionnaires
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