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Intensive Insulin Treatment in Patients with Recurrent Hypoglycemia
- Paul M. Rosman, DO
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TO THE EDITOR:
The thoughtful perspective on hypoglycemia unawareness by Hoeldtke and Boden [1] ended with the stunning conclusion that intensive insulin therapy should probably be withheld from patients with recurrent hypoglycemia. To support this conclusion, they cite the Diabetes Control and Complications Trial, which they say “has confirmed that the prevalence of severe hypoglycemia remains a major obstacle to attempts to prevent diabetic complications with intensive insulin therapy” [1]. My reading of the report leads me to a different conclusion. The report states that “because of the risk, intensive insulin therapy should be implemented with caution, especially in patients with repeated severe hypoglycemia or awareness of hypoglycemia” [2].
The decision to initiate intensive insulin therapy in a patient with recurrent hypoglycemia deserves to be made clinically and should be based on the ability to establish “patient-driven” intensive management of diabetes control in individual patients. During the Diabetes Control and Complications Trial, this approach was used with frequent success (Kruger D. Personal communication) to minimize recurrent or severe hypoglycemia in the intensively treated patients. Further, Cox and colleagues [3] have shown that behavior modification techniques emphasizing blood glucose awareness training “result in reductions of severe hypoglycemic episodes and automobile crashes in the long-term”
Paul M. Rosman, DO
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
