Hypoglycemia-Associated Autonomic Failure in Type 1 Diabetes
Hypoglycemic episodes are a frequent complication in type 1 diabetes, as a result of the long-term effort to maintain glucose levels within the euglycemic range. Frequent hypoglycemic events may lead to the development of hypoglycemia unawareness, a gradually developing phenomenon defined as a patient’s inability to detect an impending hypoglycemia event. It is also known as hypoglycemia-associated autonomic failure (HAAF), is enhanced by antecedent hypoglycemia, and affects as many as 29% of children and adolescents with type 1 diabetes. The importance of establishing early the diagnosis of adrenal insufficiency is crucial in these cases because a severe hypoglycemic episode may easily evolve into a life-threatening situation.

The dissection of a severe hypoglycemic episode may reveal an abnormal counterregulatory response in a patient with type 1 diabetes. HAAF in the context of non-tight glycemic regulation may point to a different etiology than hypoglycemia unawareness. Coexistent adrenal insufficiency must be suspected when severe hypoglycemic episodes are followed by impaired autonomic response and predominant neuroglycopenic symptoms. The combination of type 1 diabetes and other autoimmune endocrinopathies is part of an autoimmune polyglandular syndrome.

Source: https://diabetesjournals.org/clinical/article/40/2/250/138889/Hypoglycemia-Associated-Autonomic-Failure-in-Type
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