INS and Hypoglycemia: Other putative mechanisms that may contribute to the development of impaired hypoglycaemia awareness include the actions of external neuronal modulators, such as opioids, serotonin, steroids, cytokines or urocortin, all of which have been shown to modulate the counterregulatory response to insulin‐induced hypoglycaemia and can affect changes in neurotransmitter synthesis or release, or changes in synaptic structure or alterations in neurotransmitter release and/or action.3, 13, 40