Hypoglycemia and the central nervous system.

The Diabetes Control and Complications Trial (DCCT) convincingly demonstrated that intensive insulin therapy reduces the microvascular complications associated with diabetes, including retinopathy, neuropathy, and nephropathy. However, intensive insulin therapy that lowers blood glucose towards normal levels also significantly increases the risk for hypoglycemia. Moderate hypoglycemia can acutely affect cognitive ability, leading to temporary stupor and confusion. Severe hypoglycemia can lead to seizures, coma, and even death. Therefore, hypoglycemia causes recurrent morbidity that can interfere with the ability of individuals to work, as well as to perform activities of daily living. The fear of a hypoglycemic reaction is also a barrier to intensive insulin therapy.