Rates of hypoglycaemia in those with Type 2 diabetes newly started on insulin are less than in Type 1 diabetes but rise with time. As insulin secretion declines, the ability to release glucagon is diminished. Adrenaline release partially compensates for deficient glucagon secretion but is vulnerable to repeated hypoglycaemia leading to diminished sympathoadrenal activation. Thus the inevitable decline in endogenous insulin, eventually produces a similar failure of physiological protection to hypoglycaemia as in Type 1 diabetes.