The main risk of insulin therapy, which is increased with tight glycaemic
control, is hypoglycaemia. Recurrent episodes of hypoglycaemia are suggested
to cause permanent cognitive impairment, but recent data does
not support this link.3
Dawn versus Somogyi phenomena: There is a normal rise in plasma
glucose concentrations in the early morning. This is believed to be due to
increased growth hormone secretion overnight that leads to mild insulin