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Online Letters: Comments and Responses

Glycemic Control and Hypoglycemia: Is the Loser the Winner?

Response to Clark

  1. Lawrence C. Perlmuter, PHD12,
  2. Brian P. Flanagan3,
  3. Parinda H. Shah3 and
  4. Sant P. Singh, MD2
  1. 1Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  2. 2Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  3. 3Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  1. Corresponding author: Lawrence C. Perlmuter, lawrence.perlmuter{at}rosalindfranklin.edu
Diabetes Care 2009 Mar; 32(3): e33-e33. https://doi.org/10.2337/dc08-2199
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Response to Clark

We thank Dr. Clark and concur with his appropriate comments about the severity of hypoglycemic symptoms in type 1 diabetic subjects (1,2). The glycemic thresholds to activate the neuroendocrine, autonomic nervous system, and metabolic counterregulatory responses to hypoglycemia are dynamic rather than static. In regard to any limitations on diabetic subjects to pursue employment opportunities, clinical practice recommendations by the American Diabetes Association indicate as follows: “Any person with diabetes, whether insulin dependent or non–insulin dependent, should be eligible for any employment for which he/she is otherwise qualified” (3). We support this statement. Whereas the inherent risk of severe hypoglycemia can never be eliminated in people treated with insulin, an evaluation of risk should be made on an individual basis.

Acknowledgments

No potential conflicts of interest relevant to this article were reported.

Footnotes

  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

  • DIABETES CARE

References

  1. ↵
    Clark CM: Glycemic control and hypoglycemia: is the loser the winner? (Letter). Diabetes Care 32:e32, 2009. DOI: doi:10.2337/dc08-2047
    OpenUrlFREE Full Text
  2. ↵
    Perlmuter LC, Flanagan BP, Shah PH, Singh SP: Glycemic control and hypoglycemia: is the loser the winner? Diabetes Care 31:2072–2076, 2008
    OpenUrlFREE Full Text
  3. ↵
    American Diabetes Association: Hypoglycemia and employment/licensure. Diabetes Care 31(Suppl. 1):S94, 2008
    OpenUrlFREE Full Text
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Diabetes Care: 32 (3)

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March 2009, 32(3)
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Glycemic Control and Hypoglycemia: Is the Loser the Winner?
Lawrence C. Perlmuter, Brian P. Flanagan, Parinda H. Shah, Sant P. Singh
Diabetes Care Mar 2009, 32 (3) e33; DOI: 10.2337/dc08-2199

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Glycemic Control and Hypoglycemia: Is the Loser the Winner?
Lawrence C. Perlmuter, Brian P. Flanagan, Parinda H. Shah, Sant P. Singh
Diabetes Care Mar 2009, 32 (3) e33; DOI: 10.2337/dc08-2199
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