Is hypoglycaemia an inevitable accompaniment to improved glycaemic control?
Hypoglycaemia, particularly nocturnal, is a major treatment-associated complication of diabetes.3, 6, 7 Indeed, it is considered to be the main barrier to the effective management of diabetes.8, 9 Mild episodes of hypoglycaemia are associated with symptoms of sweating, palpitations, tremor, loss of concentration and confusion and are unpleasant for the patient. Severe episodes can cause convulsions and coma, and are especially feared by patients.10 Nocturnal hypoglycaemia is common with the use of insulin regimens and the threat of this metabolic problem may potentially have serious consequences. During the DCCT, 43% of severe hypoglycaemic episodes occurred during sleep.3, 5A basal insulin supply, supplemented by multiple preprandial injections of insulin, is central to intensive blood-glucose control in both type I and II diabetes. An ideal basal insulin would provide a prolonged, constant and consistent activity profile when administered subcutaneously. Conventional basal insulins,
