Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

Figure 2 Putative mechanisms of hypoglycemia unawareness. Recurrent hypoglycemia results in a reduced autonomic response to hypoglycemia with attenuation of autonomic warning symptoms. The maladaptive response in the brain is characterized by increased glucose transporter 1 (GLUT1) activity in a bid to preserve brain function and alter glucose sensing in the ventromedial hypothalamus (VMH), mediated by elevated levels of gamma aminobutyric acid (GABA). Adapted from Iqbal et al[12] with permission from Elsevier. Citation: Iqbal A, Heller S. Managing hypoglycaemia. Best Pract Res Clin Endocrinol Metab 2016; 30: 413-430. Copyright © Elsevier.