ABSTRACT
Hypoglycemia is a major factor preventing patients with both type 1 and type 2 diabetes from achieving near-normal glycemia. The risk of hypoglycemia in diabetic patients is due to both the imperfect pharmacokinetics of current therapy that produces inappropriately high insulin concentrations and a failure in the physiological protective mechanism that limits the decrease in blood glucose concentrations. A single threshold value for plasma glucose concentration that defines hypoglycemia in diabetes cannot be assigned. The insufficient contribution of glucose to the brain with an associated cerebral reduction of oxygen causes neuroglycopenic symptoms. Glucose, in physiological conditions, provides 90% of the energy necessary for brain functioning, and the cerebral functions are totally dependent on the level of the circulating glucose. In pregnant women with intensively treated type 1 diabetes, consistent lower epinephrine and glucagon responses were found with respect to nondiabetic nonpregnant women.
