The study aims to obtain a panel of biomarkers from hypoglycemic diabetic patients with either type 1 or type 2 diabetics and from control patients with type 1 or type 2 diabetes who didn't have hypoglycemia in the last 72 hours.

Primary endpoint is establishing a panel of biomarkers from 100 hypoglycemic diabetic patients with type 1 or type 2 Diabetes during the incidence of hypoglycemia by taking a single blood sample to be analyzed for HbA1c, LDL, HDL, Triglycerides, CRP, CBC and biochemical analysis including liver and kidney function tests. In addition to 5 ml serum sample to be centrifuged and stored in RCSI lab.

Inpatient hypoglycemic patients may also be included in group of hypoglycemia and will be required to have a serial of blood samples taken to be analyzed on the 1st hour, 2nd hour, 3rd hour and 4th hour after the hypoglycemic event.

Secondary endpoint involves recruitment of 100 control Diabetic patients with type 1 or type 2 Diabetes to establish a panel of biomarkers by obtaining a blood sample for the HbA1c, LDL, HDL, Triglycerides, CRP, CBC and biochemical analysis including liver and kidney function tests to include 50 subjects fasting overnight and the other 50 subjects to be non-fasting but without having hypoglycemia at the time of recruitment or in the last 72 hours.

Inclusion Criteria:

Inclusion criteria for diabetes subjects with hypoglycemia

• Diagnosed of type 2 diabetes or type 1 based on the WHO guidelines Patient's age from 21-75 years old
• Able to say when the hypo had occurred (free style libre in the outpatient setting, or documented blood glucose less than < 4 mmol/l (<70 mg/dl) as an inpatient

Inclusion criteria for diabetes subjects without hypoglycemia:

• Diagnosed of type 2 diabetes or type 1 based on the WHO guidelines
• Patient's age from 21-75 years old
• No hypoglycemia or hypoglycemia unawareness.

Exclusion Criteria:

• eGFR less than 45 ml/min
• Liver enzymes 3 folds greater than upper limit
• Pregnancy
• Patients on steroids or Atypical Antipsychotics or Cyclosporine/Tacrolimus or other medications that may mask hypoglycemia

Exclusion Criteria for diabetes subjects with hypoglycemia

• Unable to determine when hypoglycemic event had taken place
• Hypoglycemic unawareness
• Severe hypoglycemic event in the last 3 months

Exclusion criteria for diabetes subjects without hypoglycemia

• Hypoglycemic event in the preceding week
• Hypoglycemic unawareness

Type 1 or type 2 Diabetic subjects with and without hypoglycemic event to be included either in hypoglycemic group or in Control group.

Monitoring, audits, and REC review will be permitted and provide direct access to source data and documents. The Lead PI and the researchers assigned by him will have access to the stored data/specimens. Only the Lead PI and the researchers assigned working on this study will be eligible to obtain the data/specimens from the participants during data collection

Dr Naji will act as the data custodian and is responsible for the storage, handling and quality of the study data.

Data will be collected in the case report form to allow for cross referencing to check validity.

Study documents (paper and electronic) will be retained in a secure (kept locked when not in use) location during and after the trial has finished. All essential documents including source documents will be retained for a period of 3 years after study completion (last patient, last study point). A label stating the date after which the documents can be destroyed will be placed on the inside front cover of the case notes of trial participants.

Study documents (paper and electronic) will be retained in a secure (kept locked when not in use) location during and after the trial has finished.