Hypoglycemic counterregulation in normal and diabetic man

Insulin-induced hypoglycemia has long represented a troublesome complication in the treatment of diabetes mellitus. This problem has recently gained special significance, as efforts to normalize glycemia in type I diabetics have become increasingly aggressive. With these more vigorous attempts to achieve meticulous metabolic control, and their attendant risk of hypoglycemia, interest has been rekindled in the physiologic mechanisms subserving hypoglycemic counterregulation and how these mechanisms are altered in the insulin-treated diabetic. This review summarizes our current understanding of glucose counterregulation in normal man, with particular emphasis on the important differences observed in patients with type I diabetes.