<qa>  What is the major limiting factor in gaining tight control of blood sugar inBackgroundRationale: The diabetes control and complications trial DCCT showed that improving blood sugar control for individuals with type 1 diabetes T1DM stopped or delayed the onset of long-term complications. As a result of the study, intensive management to control blood sugar and glycosylated hemoglobin as near to normal as safely as possible is advocated. However, hypoglycemia was increased 3 fold in the DCCT study and is the major limiting factor in gaining tight control of blood sugar in T1DM. 