Copyright © 2015 by the American Osteopathic Association. From: Insulin Therapy for Challenging Patient Cases J Am Osteopath Assoc. 2013;113(4_suppl_2):S17-S28. Figure Legend: Thresholds for symptomatic hypoglycemia vary with age. With increasing age, the potential reaction time between awareness and onset of symptoms is decreased, contributing to an increased risk for asymptomatic hypoglycemia and a greater susceptibility to cognitive impairment. Age designations are presented as mean [standard deviation] years. Data are for nondiabetic patients with no family history of diabetes.25,26 Reprinted with permission from the American Diabetes Association, from Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care. 2005;28(12):2948-2961 and from Matyka K et al. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997;20(2):135-141; permission conveyed through Copyright Clearance Center, Inc. Date of download: 10/4/2017 Copyright © 2015 by the American Osteopathic Association. All rights reserved.