Hypoglycaemia in Clinical Diabetes

PrefaceIn the second edition of this book, we have continued to emphasise the clinical significanceof hypoglycaemia to the person who has diabetes, particularly when receiving treatmentwith insulin. Since the first edition of the book was published in 1999, new therapies haveemerged, including new insulin analogues and inhaled insulin, and monitoring systems arenow available that can provide continuous recording of blood glucose. However, far fromminimising the risk of hypoglycaemia in clinical practice, the newer treatments have beenshown to be as liable to cause hypoglycaemia as before, while continuous blood glucosemonitoring has revealed that this side-effect of insulin therapy is even more common thanwas believed previously. The frequency of severe hypoglycaemia in vulnerable groups suchas children and elderly people receiving insulin therapy is unacceptably high, and presentspotentially serious risks to health as well as diminishing their quality of life. Much scientificresearch in recent years has focused on the effects of hypoglycaemia on the brain, providinga greater understanding of the protean effects of this metabolic abnormality. New data andconcepts have been incorporated in this edition, particularly where these are of importanceto clinical practice.In updating and revising this book about hypoglycaemia, particular emphasis has beengiven to the risk factors for hypoglycaemia and how these may be reduced or avoided. Newchapters have been included to discuss recognised moderators of hypoglycaemia and the roleof new glucose monitoring systems, to address the increasing problem of hypoglycaemia inpeople with type 2 diabetes and the elderly person, and to acknowledge the major importanceof nocturnal hypoglycaemia, which is frequently not identified in clinical practice but canhave serious consequences, not only in its immediate morbidity, but also in promoting thedevelopment of the acquired syndromes of hypoglycaemia.We are grateful for the expert assistance and support of the colleagues who havecontributed chapters, some of whom are new as authors for this edition. All have skillfullyhighlighted the relevance of the enhancement of scientific knowledge in this field to theeveryday management of diabetes, which we hope will assist all members of the diabetesteam in their efforts to prevent and manage the extremely common but unwanted scourgethat is hypoglycaemia.Brian M. FrierMiles Fisher