Clinical Characteristics of Type 1 Diabetic Patients With and Without Severe Hypoglycemia O R I G I N A L A R T I C L EOBJECTIVE -To investigate the frequency of severe hypoglycemia (SH) and hypoglycemic coma and to identify clinical and behavioral risk indicators in a nonselected population of type 1 diabetic patients. RESEARCH DESIGN AND METHODS-This study involved a retrospective clinical survey of 195 consecutive patients using a questionnaire addressing the frequency of SH (i.e., help from others required) and hypoglycemic coma during the previous year, general characteristics, behavior, hypoglycemia awareness, and the Hypoglycemia Fear Survey. Data regarding diabetes, treatment, long-term complications, comorbidity, and comedication were obtained from the patients' medical records.RESULTS -A total of 82% of subjects were receiving intensive insulin treatment, and mean ± SD HbA 1c was 7.8 ± 1.2%. Mean duration of diabetes was 20 ± 12 years. The occurrence of SH (including hypoglycemic coma) was 150 episodes/100 patient-years and affected 40.5% of the population. Hypoglycemic coma occurred in 19% of subjects (40 episodes/100 patient-years). CONCLUSIONS -SH and hypoglycemic coma are common in a nonselected population with type 1 diabetes. The presence of long-term complications, a threshold for symptoms of Ͻ3 mmol/l, alcohol use, and (nonselective) ␤-blockers were associated with SH during the previous year. If prospectively confirmed, these results may have consequences for clinical practice.

Slower absorption from deltoid and femoral administrations resulted in an increased duration of action for both regular insulin and insulin lispro when compared to abdominal administration. However, notable increases in the onset of action were only apparent with regular insulin. The consistency with insulin lispro response from abdominal and extremity injection sites allows more potential sites for subcutaneous injection with an assured rapid response.

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