Normal glucose metabolism is essential for life. Hormones including insulin, glucagon, epinephrine, cortisol and growth hormone are responsible for blood glucose homeostasis in our body. In reaction to hypoglycemia, insulin secretion decreases first, followed by increase in glucagon and then epinephrine secretion. Excessive epinephrine action is also related to the symptoms of hypoglycemia. In patients with type I diabetes mellitus, hypoglycemia associated autonomic failure is not uncommonly recognized. The risk is associated with diabetic neuropathy, reduced epinephrine response and prior hypoglycemia events. Once hypoglycemia can be avoided, the defects can be partially reversed.
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