Further defects in counterregulatory responses induced by recurrent hypoglycemia in IDDM

Maris R. Davis, Michael Mellman, Harry Shamoon

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Abstract

We evaluated the effect of previous experimental hypoglycemie on counterregulatory responses to hypoglycemie in 13 IDDM patients. These patients had defects in counterregulatory responses to hypoglycemie compared with 7 nondiabetic control subjects. Plasma EPI and glucagon responses to hypoglycemia in IDDM patients were ∼60% of levels in nondiabetic subjects (P < 0.02 and P < 0.001, respectively). Hepatic glucose output ([3-3H]glucose) was reduced by ∼60% of normal (P < 0.005), and the glucose infusion rate required to maintain plasma glucose was correspondingly greater in people with IDDM (P < 0.001). With a modified glucose clamp (plasma insulin ∼330 pM), the diabetic subjects underwent two sequential 120-min periods of hypoglycemia (∼3.0 mM) with an intervening 60-min euglycemic recovery period. In the IDDM patients, there were 30-50% decreases in plasma GH (P < 0.005) and Cortisol (P < 0.001) responses during the second hypoglycemic period compared with the first. In addition, glucose output, already defective compared with that in nondiabetic subjects, was further reduced by 33% (P = 0.03) during the second period of experimental hypoglycemia. There was no effect of repeated hypoglycemia on the responses of plasma glucagon, EPI, or NE, though plasma EPI was correlated directly with glucose output (P < 0.001) and inversely with glucose uptake (P < 0.05). There was no correlation between the rise in glucose output during hypoglycemia and antecedent glycemic control as measured by HbA1. We conclude that in IDDM patients with preexisting defects in counterregulatory responses to hypoglycemia, recurrent, mild hypoglycemia is associated with additional reductions in pituitary-adrenocortical hormonal secretion and further impairment of hepatic glucose production.

Original languageEnglish (US)
Pages (from-to)1335-1340
Number of pages6
JournalDiabetes
Volume41
Issue number10
StatePublished - Oct 1992

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Type 1 Diabetes Mellitus
Hypoglycemia
Glucose
Glucagon
Glucose Clamp Technique
Liver
Glycosylated Hemoglobin A
Hypoglycemic Agents
Hydrocortisone
Insulin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Further defects in counterregulatory responses induced by recurrent hypoglycemia in IDDM. / Davis, Maris R.; Mellman, Michael; Shamoon, Harry.

In: Diabetes, Vol. 41, No. 10, 10.1992, p. 1335-1340.

Research output: Contribution to journalArticle

Davis, Maris R. ; Mellman, Michael ; Shamoon, Harry. / Further defects in counterregulatory responses induced by recurrent hypoglycemia in IDDM. In: Diabetes. 1992 ; Vol. 41, No. 10. pp. 1335-1340.
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abstract = "We evaluated the effect of previous experimental hypoglycemie on counterregulatory responses to hypoglycemie in 13 IDDM patients. These patients had defects in counterregulatory responses to hypoglycemie compared with 7 nondiabetic control subjects. Plasma EPI and glucagon responses to hypoglycemia in IDDM patients were ∼60{\%} of levels in nondiabetic subjects (P < 0.02 and P < 0.001, respectively). Hepatic glucose output ([3-3H]glucose) was reduced by ∼60{\%} of normal (P < 0.005), and the glucose infusion rate required to maintain plasma glucose was correspondingly greater in people with IDDM (P < 0.001). With a modified glucose clamp (plasma insulin ∼330 pM), the diabetic subjects underwent two sequential 120-min periods of hypoglycemia (∼3.0 mM) with an intervening 60-min euglycemic recovery period. In the IDDM patients, there were 30-50{\%} decreases in plasma GH (P < 0.005) and Cortisol (P < 0.001) responses during the second hypoglycemic period compared with the first. In addition, glucose output, already defective compared with that in nondiabetic subjects, was further reduced by 33{\%} (P = 0.03) during the second period of experimental hypoglycemia. There was no effect of repeated hypoglycemia on the responses of plasma glucagon, EPI, or NE, though plasma EPI was correlated directly with glucose output (P < 0.001) and inversely with glucose uptake (P < 0.05). There was no correlation between the rise in glucose output during hypoglycemia and antecedent glycemic control as measured by HbA1. We conclude that in IDDM patients with preexisting defects in counterregulatory responses to hypoglycemia, recurrent, mild hypoglycemia is associated with additional reductions in pituitary-adrenocortical hormonal secretion and further impairment of hepatic glucose production.",
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