The hormonal and metabolic responses to prolonged hypoglycemia.

The purpose of this review was to summarize some of the recent advances that have been made in the understanding of the physiology involved in the counter-regulatory response to prolonged hypoglycemia. It is hoped that this review may stimulate thought and increase awareness that other factors, in addition to the glycemic level, can affect the counterregulatory response. However, if the goal of tight metabolic control is to be achieved in subjects with diabetes, the spectre of severe hypoglycemia must be removed. Thus further work is needed to understand the physiologic mechanisms controlling hypoglycemic counterregulation in normal subjects and the syndromes of abnormal counterregulatory responses present in subjects with IDDM.