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Cited by 273Diabetes Management and ResearchPancreatic function and diabetesDiabetes Treatment and Management

Glucose counterregulation, hypoglycemia, and intensive insulin therapy in diabetes mellitus

Epstein, Franklin H., Cryer, Philip E., Gerich, John E.·1985·New England Journal of Medicine
DOI 10.1056/nejm198507253130405
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Abstract

The prevention or correction of hypoglycemia is the result of both dissipation of insulin and activation of counterregulatory systems. In the models studied to date, glucagon and epinephrine have been shown to be the key counterregulatory factors; the potential roles of other hormones, neural factors, or substrate mechanisms in other models and during more gradual recovery from hypoglycemia remain to be defined. Deficient glucagon responses to decrements in plasma glucose, which are common in patients with IDDM and occur in some patients with NIDDM, result in altered counterregulation. But counterregulation is generally adequate, because epinephrine compensates for it. Defective glucose counterregulation due to combined deficiencies of glucagon and epinephrine secretory responses occurs in many patients, typically those with longstanding diabetes, and must be added to the list of factors known to increase the risk of hypoglycemia, at least during intensive therapy. From the material reviewed, it should be apparent that much has been learned about glucose counterregulation. It should be equally clear that much remains to be learned. Among the many possibilities, we consider four worthy of emphasis. First of all, we need to examine the physiology and pathophysiology of glucose counterregulation in additional models (e.g., during exercise) and over longer periods. Secondly, we need to determine whether central nervous system adaptation to antecedent glycemia occurs and, if so, i…

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  • A sensation of palpitation may stem from sinus tachycardia and/or increased cardiac contractility, both of which may have various causes: fever, anaemia, orthostatic hypotension, hyperthyroidism/thyreotoxicosis, postmenopausal syndrome, pregnancy, hypoglycaemia, hypovolaemia, pheochromocytoma, arteriovenous fistula, postural orthostatic tachycardia syndrome, among others.

    “A sensation of palpitation may stem from sinus tachycardia and/or increased cardiac contractility, both of which may have various causes: fever, anaemia, orthostatic hypotension, hyperthyroidism/ thyreotoxicosis, postmenopausal syndrome, pregnancy, hypoglycaemia, hypovolaemia, pheochromocytoma, arteriovenous fistula, postural orthostatic tachycardia syndrome, among others.31 -39”

    From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [31]

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Authors
Epstein, F. H., Cryer, P. E., & Gerich, J. E.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1985-07-25
Volume
313
Issue
4
Pages
232-241
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm198507253130405
OpenAlex
W2339035787
Semantic Scholar
c07b6bdf726219fb5fc5bbd922a96e251f85f6eb
Cited by
273
References
21
Citations by year
2026: 1 · 2024: 4 · 2023: 9 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 3 · 2015: 6 · 2014: 5 · 2013: 8 · 2012: 7
FWCI
4.15
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
glucose counterregulation, hypoglycemia, intensive insulin therapy, diabetes mellitus, glucagon, epinephrine, insulin resistance, type 1 diabetes, type 2 diabetes, central nervous system adaptation, insulin delivery, normoglycemia
MeSH terms
Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Epinephrine, Glucagon, Glucose, Humans, Hydrocortisone, Hyperglycemia, Hypoglycemia, Insulin, Islets of Langerhans, Liver, Growth Hormone, Neurotransmitter Agents

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