Residual insulin secretion is not coupled to a maintained glucagon response to hypoglycaemia in long‐term type 1 diabetes
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Objectives. To evaluate the influence of residual β‐cell function on glucagon secretion and glucose counter‐regulation following hypoglycaemia in type 1 diabetes. Design and subjects. The hormonal counter‐regulatory responses to standardized insulin‐induced hypoglycaemia were investigated, 18 patients with type 1 diabetes of long duration and 12 healthy subjects were investigated. Nine of the diabetic patients (diabetes duration 17 ± 1 years) had residual insulin secretion, as reflected by persistent urinary C‐peptide excretion. The other nine diabetic patients (diabetes duration 21 ± 1 years) were C‐peptide negative. Results. Similar hypoglycaemic nadirs were found in all groups (2.1–2.3 mmol L−1), whereas the recovery of plasma glucose levels was delayed similarly in the diabetic groups. In the control subjects, plasma glucagon increased (∼50%). No significant glucagon response was registered in either of the two diabetic groups. The maximum plasma adrenaline and pancreatic polypeptides (PP) responses to hypoglycaemia were comparable in the two diabetic patient groups; the peak values being lower (P < 0.05) than in the controls. Plasma noradrenaline, growth hormone and cortisol responses to hypoglycaemia were similar in all three groups. Conclusion. Residual β‐cell function in patients with long‐term type 1 diabetes is not accompanied by preservation of the glucagon response to hypoglycaemia. As the two markers of autonomic function (adrenaline and PP) were similarly reduced in the two diabetic groups, the findings instead favour the concept that the defective glucagon secretory response to hypoglycaemia is because of autonomic nervous dysfunction.
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Glucagon response declines with age of diabetes; counterregulatory response wanes with duration of diabetes following a logarithmic relationship.
“it has been shown that glucagon secretion is dependent on the duration of diabetes; 15-17 that is, counterregulatory response wanes with duration of diabetes 15 following a logarithmic relationship.”
From The UVA/PADOVA Type 1 Diabetes Simulator: New Features (2014) · cites this paper as [17]
The Introduction says that people with type 1 diabetes usually develop a diminished glucagon response to hypoglycaemia within a few years of onset, and the Discussion reports a deficient response in patients with long-standing disease. Neither section establishes that the response declines according to a logarithmic relationship with diabetes duration. (LLM, conf=0.86)
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References 39 · Cited by 13
Research works printed but not linked: 1
- Amiel SA, Tamborlane WV, Sacca `L, Sherwin RS. Hypogly- caemia and glucose counter-regulation in normal and insu- lin-dependent diabetic subjects. Diabetes Metab Rev 1988; 4: 71-89.
- Authors
- Sjöberg, S., Ahrén, B., & Bolinder, J.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Sjöberg, S.
- Venue
- Journal of Internal Medicine
- Publisher
- Wiley
- Published
- 2002-10
- Volume
- 252
- Issue
- 4
- Pages
- 342-351
- ISSN
- 0954-6820 (ISSN-L)
- 1365-2796
- OpenAlex
- W2044095101
- Cited by
- 13
- References
- 39
- Citations by year
- 2025: 1 · 2020: 1 · 2014: 3 · 2012: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Karolinska Institutet
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, residual beta-cell function, glucagon secretion, hypoglycemia, autonomic dysfunction, epinephrine, pancreatic polypeptide, C-peptide, long-standing diabetes, glucagon response
- MeSH terms
- Insulin Secretion, Adult, Autonomic Nervous System, Blood Glucose, C-Peptide, Data Interpretation, Statistical, Diabetes Mellitus, Type 1, Epinephrine, Female, Glucagon, Humans, Hydrocortisone, Hypoglycemia, Infusions, Intravenous, Injections, Subcutaneous, Insulin, Islets of Langerhans, Male, Middle Aged, Pancreatic Polypeptide, Radioimmunoassay, Growth Hormone, Time Factors
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