Endocrine Abstracts

The discovery of insulin and its subsequent mass manufacture transformed the lives of people with type 1 diabetes. Insulin replacement is not, however, without risk and it soon emerged that many individuals with type 1 diabetes experienced iatrogenic hypoglycaemia. Hypoglycaemia in type 1 diabetes has both immediate (cognitive impairment) and longer-term consequences. In this presentation I will focus on the longer-term consequences of recurrent hypoglycaemia and in particular highlight how recurrent hypoglycaemia impacts on those specialised cells in the brain that are critical to the regulation of glucose homeostasis and the counter-regulatory response to hypoglycaemia. In these cells recurrent hypoglycaemia initiates a series of adaptations that ensure they are more resilient to subsequent hypoglycaemia, but this leads to impaired hypoglycaemia awareness and a paradoxical increased risk of severe hypoglycaemia. I will review our current understanding of the underlying mechanism that are responsible for the development of impaired awareness of hypoglycaemia, proposing that this is potentially the result of a process called Habituation. Finally, I will discuss clinical strategies both established and novel that may help restore or prevent hypoglycaemia awareness in type 1 diabetes.