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February 16, 2007

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Question from India:

I have a further question about your statement in my recent question that "After a number of years, responses to hypoglycemia are decreased with decreased glucagon and epinephrine responses." In view of this, can the body system opt to maintain persisting hyperglycemia for its urgent energy requirements? How can controlling blood glucose to normal levels under the above situation adversely affect the patient?

Answer:

No, in fact, there is no control. In order to have good control, you have to run some risk of hypoglycemia. The safety net is the person’s ability to sense hypoglycemia and act on it. In the absence of a person’s ability to sense hypoglycemia, it almost requires that the blood sugar target range be maintained higher than you would want, if you were primarily shooting for a normal A1c. That is why people refer to hypoglycemia as the limiting factor in the treatment of diabetes.

JTL