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Defective glucose counterregulation after subcutaneous insulin in noninsulin-dependent diabetes mellitus. Paradoxical suppression of glucose utilization and lack of compensatory increase in glucose production, roles of insulin resistance, abnormal neuroendocrine responses, and islet paracrine interactions.
Open accessAbstract
To characterize glucose counterregulatory mechanisms in patients with noninsulin-dependent diabetes mellitus (NIDDM) and to test the hypothesis that the increase in glucagon secretion during hypoglycemia occurs primarily via a paracrine islet A-B cell interaction, we examined the effects of a subcutaneously injected therapeutic dose of insulin (0.15 U/kg) on plasma glucose kinetics, rates of glucose production and utilization, and their relationships to changes in the circulating concentrations of neuroendocrine glucoregulatory factors (glucagon, epinephrine, norepinephrine, growth hormone, and cortisol), as well as to changes in endogenous insulin secretion in 13 nonobese NIDDM patients with no clinical evidence of autonomic neuropathy. Compared with 11 age-weight matched nondiabetic volunteers in whom euglycemia was restored primarily by a compensatory increase in glucose production, in the diabetics there was no compensatory increase in glucose production (basal 2.08 +/- 0.04----1.79 +/- 0.07 mg/kg per min at 21/2 h in diabetics vs. basal 2.06 +/- 0.04----2.32 +/- 0.11 mg/kg per min at 21/2 h in nondiabetics, P less than 0.01) despite the fact that plasma insulin concentrations were similar in both groups (peak values 22 +/- 2 vs. 23 +/- 2 microU/ml in diabetics and nondiabetics, respectively). This abnormality in glucose production was nearly completely compensated for by a paradoxical decrease in glucose utilization after injection of insulin (basal 2.11 +/- 0.03----1.86 +/- 0.06 mg/kg per min at 21/2 h in diabetics vs. basal 2.08 +/- 0.04----2.39 +/- 0.11 mg/kg per min at 21/2 h nondiabetics, P less than 0.01), which could not be accounted for by differences in plasma glucose concentrations; the net result was a modest prolongation of hypoglycemia. Plasma glucagon (area under the curve [AUC] above base line, 12 +/- 3 vs. 23 +/- 3 mg/ml X 12 h in nondiabetics, P less than 0.05), cortisol (AUC 2.2 +/- 0.5 vs. 4.0 +/- 0.7 mg/dl X 12 h in nondiabetics, P less than 0.05), and growth hormone (AUC 1.6 +/- 0.4 vs. 2.9 +/- 0.4 micrograms/ml X 12 h in nondiabetics, P less than 0.05) responses in the diabetics were decreased 50% while their plasma norepinephrine responses (AUC 49 +/- 12 vs. 21 +/- 5 ng/ml X 12 h in nondiabetics, P less than 0.05) were increased twofold (P less than 0.05) and their plasma epinephrine responses were similar to those of the nondiabetics (AUC 106 +/- 17 vs. 112 +/- 10 ng/ml X 12 h in nondiabetics). In both groups of subjects, increases in plasma glucagon were inversely correlated with plasma glucose concentrations (r = -0.80 in both groups, P less than 0.01) and suppression of endogenous insulin secretion (r = -0.57 in nondiabe
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“In type 2 diabetes, the glucagon response to hypoglycemia has been diversely reported as being either modestly diminished (16, 30,50) or preserved (33,34,37,38).”
From Hypoglycemia in Type 2 Diabetes (2005) · cites this paper as [30]
In the citing paper
“Interpretation of the early studies is limited by heterogeneity of study design (29), differences in blood glucose nadir between the diabetic and control groups (30,31), a lack of agematched control subjects (31), and the disparate methods used to induce hypoglycemia (30 -35).”
From Hypoglycemia in Type 2 Diabetes (2005) · cites this paper as [30]
In the citing paper
“Plasma free fatty acids increase in response to hypoglycemia in type 2 diabetes (30,33,50) but do not in type 1 diabetes (54).”
From Hypoglycemia in Type 2 Diabetes (2005) · cites this paper as [30]
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Self-citationHypoglycemia — mechanisms and prevention in NIDDM treatment with insulin
Zahnd, G. R. (1988) · Diabetes Research and Clinical Practice · doi:10.1016/0168-8227(88)90016-2 · Cited by 1
ON THE ORIGIN OF NON-INSULIN DEPENDENT DIABETES MELLITUS
O'Hare, J. (1985) · The Lancet · doi:10.1016/s0140-6736(85)90310-1 · Cited by 1
Atypical mycobacterial infection of a finger
Leung, D., & Venkatesan, P. (2000) · The Lancet · doi:10.1016/s0140-6736(00)03309-2
Mohan, N., P, G. K. K., Jayachandran, A. K., P, S. T., Ajith, V., Bharath Prasad, S., Karunanithi, K., Arun Kumar, K., Manohar, V., & Nandu., M. (2015) · Universal Journal of Medical Science · doi:10.13189/ujmsj.2015.030402
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Siegmund, T., & Schumm‐Draeger, P. (2014) · Der Diabetologe · doi:10.1007/s11428-014-1264-y
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Thrasher, M. A. J. R. (2015) · Journal of Diabetes & Metabolism · doi:10.4172/2155-6156.1000576
Somatostatin Receptor Type 2 (SSTR2) Antagonism and Hypoglycemia in Diabetes
Yue, J. T. Y. (2012) · TSpace (University of Toronto)
Metadata
- Authors
- Bolli, G. B., Tsalikian, E., Haymond, M. W., Cryer, P. E., & Gerich, J. E.
- Affiliations
- Mayo Clinic (US)
- Venue
- Journal of Clinical Investigation
- Published
- 1984-06-01
- Volume
- 73
- Issue
- 6
- Pages
- 1532-1541
- ISSN
- 0021-9738 (ISSN-L)
- PMC
- PMC437063
- OpenAlex
- W2010800358
- Semantic Scholar
- 786d58ad6f63ba856c5f63459c3b3032b1cf5333
- Cited by
- 108
- References
- 57
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 7 · 2013: 2 · 2012: 3
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fogarty International Center
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, glucose counterregulation, hypoglycemia, glucagon secretion, insulin resistance, glucose production, glucose utilization, neuroendocrine response, epinephrine, norepinephrine, growth hormone, cortisol, endogenous insulin secretion, subcutaneous insulin
- MeSH terms
- Adult, Blood Glucose, Blood Pressure, C-Peptide, Diabetes Mellitus, Type 2, Female, Glucose, Glycolysis, Heart Rate, Glycated Hemoglobin, Hormones, Humans, Injections, Subcutaneous, Insulin, Kinetics, Male, Middle Aged, Reference Values
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