Approximately 25% of patients with type 1 diabetes have lost the capacity to timely detect
hypoglycaemia, a condition referred to as impaired awareness of hypoglycaemia (IAH) that
causes a six-fold higher risk of severe, potentially hazardous, hypoglycaemia. IAH is usually
the end-result of a process of habituation to recurrent hypoglycaemia that is potentially
reversible. Treatment with sodium glucose cotransporter (SGLT)-2 inhibitors (SGLT-2i) in
addition to insulin therapy may decrease the incidence of hypoglycaemia in patients with type
1 diabetes. This study will test the hypothesis that treatment with the SGLT-2 inhibitor,
dapagliflozin, added to basal-bolus insulin therapy will improve awareness of hypoglycaemia
in patients with type 1 diabetes and IAH. In a randomized doubleblind placebo-controlled
cross-over trial, patients will be treated for 8 weeks with dapagliflozin (or placebo), after
which hypoglycemic symptoms and counterregulatory hormone responses will be examined during a
hyperinsulinemic hypoglycemic glucose clamp study.