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Intermittent Hypoglycemia Impairs Glucose Counterregulation
Abstract
IDDM patients who maintain strict glycemic control have impaired counterregulatory hormone and symptomatic responses to hypoglycemia. To test the hypothesis that intermittent exposure to hypoglycemia plays an etiological role in these defective responses, we produced 4 consecutive daily episodes of hypoglycemia in 10 healthy, nondiabetic volunteers by using the insulin clamp technique. Fasting (5.3 ± 0.1 vs. 5.4 ± 0.1 mM) and nadir (2.3 ± 0.1 vs. 2.4 ± 0.1 mM) glucose levels achieved during insulin infusion did not differ on study days 1 and 4. In contrast, the glucose levels required to stimulate an increase in EPI (2.8 vs. 3.1 mM), glucagon (2.8 vs. 3.2 mM), cortisol (2.4 vs. 2.9 mM), GH (2.6 vs. 3.0 mM), and autonomic hypoglycemic symptoms (2.2 vs. 2.5 mM) were all significantly lower on study day 4 versus study day 1 (P < 0.005–0.05). Basal levels of EPI and cortisol, but not glucagon, GH, or NE also were reduced on the final study day. We conclude that intermittent hypoglycemia can result in attenuation of the hormonal and symptomatic responses to insulin-induced hypoglycemia and may contribute to the defective counterregulatory responses in patients with well-controlled IDDM.
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“Further, lowering blood glucose levels to around 60 mg/dL generally activates the hormonal counterregulatory response in healthy adults”
From Stress, hypoglycemia, and the autonomic nervous system (2022) · cites this paper as Widom and Simonson, 1992
In the citing paper
“In healthy individuals and individuals with T1DM and T2DM, antecedent hypoglycemia attenuates the sympathoadrenal, hormonal, and neuroglycopenic responses to subsequent hypoglycemia”
From Stress, hypoglycemia, and the autonomic nervous system (2022) · cites this paper as Widom and Simonson, 1992
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Mitrakou, A., Fanelli, C., Veneman, T., Perriello, G., Calderone, S., Platanisiotis, D., Rambotti, A., Raptis, S., Brunetti, P., Cryer, P., et al. (1993) · New England Journal of Medicine · doi:10.1056/nejm199309163291203 · Cited by 221
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Metadata
- Authors
- Widom, B., & Simonson, D. C.
- Affiliations
- Department of Internal Medicine, Joslin Diabetes Center; and the New England Deaconess Hospital and Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1992-12-01
- Volume
- 41
- Issue
- 12
- Pages
- 1597-1602
- ISSN
- 0012-1797
- 1939-327X
- Cited by
- 65
- References
- 0
- Language
- en
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