Nocturnal Hypoglycemia in Aggressively Controlled Diabetes

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Abstract
To the Editor: In the November 12 issue of the Journal Boden et al. described a diabetic patient with permanent brain damage secondary to hypoglycemia who lacked all counterregulatory responses to hypoglycemia.1 Other investigators had recognized previously2 that the normal glucagon response to hypoglycemia was reduced or absent in most patients with Type I diabetes, making them dependent on the catecholamine response as a fail-safe against persistent hypoglycemia. The patient of Boden et al. lacked a catecholamine response to hypoglycemia and was thus defenseless against insulin-induced hypoglycemia. There was no evidence of a defect in hormone production since the responses . . .