Schematic Representation of the Concept of Hypoglycemia-Associated Autonomic Failure (HAAF) in Diabetes and the Pathogenesis of Iatrogenic Hypoglycemia including the Clinical Syndromes of Defective Glucose Counterregulation and Impaired Awareness of Hypoglycemia - Flowchart
Schematic Representation of the Concept of Hypoglycemia-Associated Autonomic Failure (HAAF) in Diabetes and the Pathogenesis of Iatrogenic Hypoglycemia including the Clinical Syndromes of Defective Glucose Counterregulation and Impaired Awareness of Hypoglycemia - 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 (relative β-cell failure) β

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 (absolute β-cell failure) β

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

Recurrent hypoglycemia

Recurrent hypoglycemia

Recurrent hypoglycemia

Recurrent hypoglycemia

Exercise / Sleep

Exercise / Sleep

Exercise / Sleep

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

Impaired awareness of hypoglycemia

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

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation Defective glucose counterregulation

Episodes of hypoglycemia

Episodes of hypoglycemia

Episodes of hypoglycemia

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Attenuated sympathoadrenal responses to hypoglycemia (HAAF)

Adrenomedullary epinephrine responses

Adrenomedullary epinephrine responses

Adrenomedullary epinephrine responses

Sympathetic neural responses

Sympathetic neural responses

Sympathetic neural responses

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation

Defective glucose counterregulation