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Altered Hierarchy of Protective Responses Against Severe Hypoglycemia in Normal Aging in Healthy Men

Matyka, Krystyna, Evans, Mark, Lomas, Jill, Cranston, Iain, Macdonald, Ian, Amiel, Stephane A·1997·Diabetes Care

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Abstract

OBJECTIVE: To investigate the effect of normal aging on the protective responses against hypoglycemia, in view of the fact that type II diabetes is primarily a disease of aging, and its treatment is associated with risk of hypoglycemia with cognitive impairment. RESEARCH DESIGN AND METHODS: Plasma glucose was lowered stepwise from 5 to 2.4 mmol/l and restored by manipulation of an infusion of 20% glucose during 220-min intravenous infusion of 1.5 mU · kg−1 · min−1 soluble insulin in 14 men; 7 were aged 60–70 years and the other 7 were 22–26 years. Changes in neurohumoral responses, subjective awareness, and choice reaction time were assessed. RESULTS: Hormonal responses were similar in the two groups, but symptoms began earlier in the younger men (at a plasma glucose of 3.6 ± 0.1 vs. 3.0 ± 0.2 mmol/l, P = 0.02) and were more intense (P = 0.03). Four-choice reaction time, a measure of psychomotor coordination, deteriorated earlier in the older men (at a plasma glucose of 3.0 ± 0.1 vs. 2.6 ± 0.1 mmol/l, P = 0.07) and to a greater degree. The difference between the glucose level for subjective awareness of hypoglycemia and the onset of cognitive dysfunction was lost in the older men (0.0 ± 0.2 vs. 0.8 ± 0.1 mmol/l, P < 0.007). CONCLUSIONS: Older men are prone to more severe cognitive impairment during hypoglycemia than younger men and are less likely to experience prior warning symptoms if blood glucose falls. This effect of normal aging may contribute to the risk of severe hypoglycemia in older diabetic patients treated with sulfonylureas and insulin.

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Authors: Matyka, K., Evans, M., Lomas, J., Cranston, I., Macdonald, I., & Amiel, S. A.
Affiliations: King's College London (GB)
Queen's Medical Centre (GB)
ORCID: Evans, Mark
Cranston, Iain
Macdonald, Ian
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 1997-02-01
Volume: 20
Issue: 2
Pages: 135-141
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.20.2.135
OpenAlex: W2125220286
Cited by: 195
References: 30
Citations by year: 2026: 5 · 2025: 1 · 2024: 8 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 11 · 2017: 11 · 2016: 9 · 2015: 11 · 2014: 11 · 2013: 9 · 2012: 12
FWCI: 1.41
Type: journal article
Language: en
Open access: closed
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: Wellcome Trust
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
Keywords: hypoglycemia, aging, cognitive impairment, neurohumoral response, reaction time, insulin-induced hypoglycemia, type 2 diabetes, sulfonylureas, older men
MeSH terms: Adult, Aged, Aging, Blood Glucose, Blood Pressure, C-Peptide, Cognition, Epinephrine, Glucagon, Heart Rate, Humans, Hydrocortisone, Hypoglycemia, Insulin, Male, Middle Aged, Psychomotor Performance, Glucose Clamp Technique, Cohort Studies, Human Growth Hormone

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Altered Hierarchy of Protective Responses Against Severe Hypoglycemia in Normal Aging in Healthy Men

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