Schematic Representation of the Concept of Hypoglycemia-Associated Autonomic Failure - Flowchart

Schematic Representation of the Concept of Hypoglycemia-Associated Autonomic Failure - Flowchart

Schematic Representation of the Concept of Hypoglycemia-Associated Autonomic Failure - Flowchart Diabetes Mellitus Diabetes Mellitus

«Flowchart»

Hypoglycemia-Associated Autonomic Failure

Hypoglycemia-Associated Autonomic Failure

Hypoglycemia-Associated Autonomic Failure

Hypoglycemia-Associated Autonomic Failure

Early T2DM
(relative β-cell failure)

Early T2DM
(relative β-cell failure)

Early T2DM
β Early T2DM

Advanced T2DM and T1DM
(absolute β-cell failure)

Advanced T2DM and T1DM
(absolute β-cell failure)

Advanced T2DM and T1DM
β Advanced T2DM and T1DM

Relative or mild-moderate absolute therapeutic hyperinsulinemia
Falling glucose levels

Relative or mild-moderate absolute therapeutic hyperinsulinemia
Falling glucose levels

Relative or mild-moderate absolute therapeutic hyperinsulinemia
Falling glucose levels

Marked absolute therapeutic hyperinsulinemia
Falling glucose levels

Marked absolute therapeutic hyperinsulinemia
Falling glucose levels

Marked absolute therapeutic hyperinsulinemia
Falling glucose levels

Isolated episodes of hypoglycemia

Isolated episodes of hypoglycemia

Isolated episodes of hypoglycemia

Isolated episodes of hypoglycemia

End

End

End

β-cell failure No ↓ insulin and no ↑ glucagon

β-cell failure No ↓ insulin and no ↑ glucagon

β-cell failure No ↓ insulin and no ↑ glucagon

β No ↓ insulin and no ↑ glucagon ↓ ↑

Exercise / Sleep

Exercise / Sleep

Exercise / Sleep

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation

↓ Adrenomedullary epinephrine responses

↓ Adrenomedullary epinephrine responses

↓ ↓ Adrenomedullary epinephrine responses ↓

↓ Sympathetic neural responses

↓ Sympathetic neural responses

↓ ↓ Sympathetic neural responses ↓

Recurrent hypoglycemia

Recurrent hypoglycemia

Recurrent hypoglycemia

Recurrent hypoglycemia

Episodes of hypoglycemia

Episodes of hypoglycemia

Episodes of hypoglycemia

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation Defective glucose counterregulation