Can a type 2 diabetic patient with persistent hyperglycemia develop glucose tolerance to a point where the body gets accustomed to higher blood glucose levels? As such, when glucose levels drop closer to normal range blood sugars, might it seem like hypoglycemia?

Yes. In patients who are poorly treated for diabetes and who have persistently high blood sugars, any fall in blood sugars may signal a premature activation of the counterregulatory hormones. It is a very common scenario that patients who have high sugars in the 300 mg/dl [16.7 mmol/L] to 400 mg/dl [22.2 mmol/L] range begin to be treated more aggressively. When sugars start coming down towards a reasonable target, they start getting hypoglycemia symptoms. Patients have to be reassured that the body will acclimate to these changes and the activation of the hormones that oppose low blood sugars will not be activated as early.

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