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Insulin therapy and hypoglycemia

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McCall, Anthony L.·2012·Endocrinology and Metabolism Clinics of North America
DOI 10.1016/j.ecl.2012.03.001PMC PMC4265808
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Abstract

Hypoglycemia is the most important and common side effect of insulin therapy. It is also the rate limiting factor in safely achieving excellent glycemic control. A three-fold increased risk of severe hypoglycemia occurs in both type 1 and type 2 diabetes with tight glucose control. This dictates a need to individualize therapy and glycemia goals to minimize this risk. Several ways to reduce hypoglycemia risk are recognized and discussed. They include frequent monitoring of blood sugars with home blood glucose tests and sometimes continuous glucose monitoring (CGM) in order to identify hypoglycemia particularly in hypoglycemia unawareness. Considerations include prompt measured hypoglycemia treatment, attempts to reduce glycemic variability, balancing basal and meal insulin therapy, a pattern therapy approach and use of a physiological mimicry with insulin analogues in a flexible manner. Methods to achieve adequate control while focusing on minimizing the risk of hypoglycemia are delineated in this article.

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  • Individuals with type 2 diabetes have lower rates of hypoglycemia than those with type 1 diabetes.

    “Individuals with type 2 diabetes are generally more insulin resistant than those with type 1 diabetes, require higher daily doses ($1 unit/kg), and have lower rates of hypoglycemia (174).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [174]

  • Individuals with type 2 diabetes are generally more insulin resistant than those with type 1 diabetes.

    “Individuals with type 2 diabetes are generally more insulin resistant than those with type 1 diabetes, require higher daily doses ($1 unit/kg), and have lower rates of hypoglycemia (174).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [174]

  • Individuals with type 2 diabetes require higher daily insulin doses (≥1 unit/kg).

    “Individuals with type 2 diabetes are generally more insulin resistant than those with type 1 diabetes, require higher daily doses ($1 unit/kg), and have lower rates of hypoglycemia (174).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [174]

    The “Hypoglycemia in Type 2 DM” section describes relative insulin resistance in type 2 diabetes, but gives no daily insulin requirement. The “Bolus Insulin Strategies” section discusses dose calculations without stating that people with type 2 diabetes generally require ≥1 unit/kg per day or higher daily doses than those with type 1 diabetes (searched: 1 unit/kg, units/kg, and comparative insulin requirements). (LLM, conf=0.76)

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Authors
McCall, A. L.
Affiliations
University of Virginia (US)
Corresponding author
McCall, Anthony L.
ORCID
McCall, Anthony L.
Venue
Endocrinology and Metabolism Clinics of North America
Publisher
Elsevier BV
Published
2012-03
Volume
41
Issue
1
Pages
57-87
ISSN
0889-8529 (ISSN-L)
DOI
10.1016/j.ecl.2012.03.001
PMC
PMC4265808
OpenAlex
W2098705100
Cited by
177
References
25
Citations by year
2026: 7 · 2025: 23 · 2024: 20 · 2023: 16 · 2022: 16 · 2021: 13 · 2020: 15 · 2019: 11 · 2018: 16 · 2017: 13 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 6 · 2012: 4
FWCI
0.93
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrinology and Metabolism Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK082805)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
insulin therapy, hypoglycemia, type 1 diabetes, type 2 diabetes, glycemic control, hypoglycemia unawareness, continuous glucose monitoring, home blood glucose monitoring, glycemic variability, insulin analogues, individualized glycemic targets
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin

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