Optimizing glucose control is critical for patients with diabetes to minimize risks of micro- and macrovascular complications associated with hyperglycaemia. To this end, individuals with diabetes who depend on insulin replacement therapy, particularly those on basal-bolus regimens, need to be aware of their blood glucose values to guide treatment decisions.
There is a line in the sand between mild and severe hypoglycaemia (SH). While mild hypoglycaemia is not trivial, it does not threaten life and health as SH does. For people who depend on insulin and other glucose-lowering drugs associated with hypoglycaemia, clinicians often consider a degree of SH “the cost of doing business” in diabetes management—in other words, an unwanted but unavoidable corollary of treatment.
Iatrogenic hypoglycaemia is the limiting factor in the glycaemic management of diabetes, particularly with insulin. That hypoglycaemia can kill experimental animals has been known since the discovery of insulin. There are now numerous reports of deaths of patients with diabetes associated with hypoglycaemia. Since hypoglycaemia can kill, and hypoglycaemia at the time of death has been documented by continuous glucose monitoring in a patient with diabetes, it is reasonable to conclude that these are causal associations.