Main idea: No single approach can be advocated for all patients, and it is the responsibility of the health care professional to identify the clinical strategy that best enables their patient to achieve this goal.
Impaired awareness of hypoglycemia (IAH) affects between 25% and 30% of all people with type 1 diabetes (T1D) and markedly increases the risk of severe hypoglycemia. This greatly feared complication of T1D impairs the quality of life and has recognized morbidity. People with T1D have an increased propensity to hypoglycemia, as a result of fundamental physiological defects in their ability to respond appropriately to a fall in blood glucose levels. With repeated exposure to low glucose, many then develop a condition referred to as IAH. There is a reduced ability to perceive the onset of hypoglycemia and take appropriate corrective action. The management of individuals with IAH relies initially on its identification in the clinic through a detailed exploration of the frequency of hypoglycemia and an assessment of the individual’s ability to recognize these episodes. In this review article, we will address the clinical strategies that may help with the management of the patient with IAH once identified, who may or may not also suffer from problematic hypoglycemia. The initial focus is on how to identify such patients and then on the variety of approaches involving educational programs and technological approaches that may be taken to minimize hypoglycemia risk.