ABSTRACT
Comprehensive treatment, including glycemic control, makes a difference for people with diabetes. Glycemic control prevents or delays the microvascular complications-retinopathy, nephropathy and neuropathy-of both type 1 diabetes (1) and type 2 diabetes (2); it may also reduce macrovascular events (3,4). However, because of the imperfections of all current treatment regimens, iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes (5). Were it not for the potentially devastating effects of hypoglycemia on the brain-which requires a continuous supply of glucose from the circulation-diabetes would be rather easy to treat. Enough insulin, or any effective drug, to lower plasma glucose concentrations to or below the normal range would eliminate the symptoms of hyperglycemia, prevent acute hyperglycemic complications (ketoacidosis, hyperosmolar syndrome), almost assuredly prevent the long-term microvascular complications (1,2) and likely reduce atherosclerotic risk to baseline (3,4). But the effects of hypoglycemia on the brain are real, and the glycemic management of diabetes is therefore complex.
