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Intensive glycemic control may increase cardiovascular risks and mortality due to hypoglycemia, which is now gradually emerging from a state of chaos into firm.The pathophysiological of glucose counter-regulation in patients with type 1 diabetes as well as type 2 diabetes for over 15 years is characterized by the loss of the defense mechanisms against hypoglycemia.Hypoglycemia causes pronounced physiological and pathophysiological effects on cardiovascular system as consequences of autonomic system activation and counter regulatory hormones release.These effects provoke a series of hemodynamic changes include an increase in heart rate and peripheral systolic blood pressure, a decrease in central blood pressure, reduced peripheral arterial resistance, and increased myocardial contractility and cardiac output.Cardiac electrophysiological changes including flattening or inversion of T waves, QT prolongation and ST segment depression were observed in both insulin-induced and spontaneous hypoglycemia.Sympathoadrenal activation is the main cause, through mechanisms that involve but are not limited to catecholamine-mediated hypokalemia.Hypoglycemia is involved in platelet activation, aggregation and secretion.There is also growing concern about its long-term effects, especially inflammation and the related atherogenesis.