Glycemic Control and Hypoglycemia: Is the Loser the Winner?

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.