Bt. Kinsley et al., DIFFERENTIAL REGULATION OF COUNTERREGULATORY HORMONE-SECRETION AND SYMPTOMS DURING HYPOGLYCEMIA IN IDDM - EFFECT OF GLYCEMIC CONTROL, Diabetes care, 18(1), 1995, pp. 17-26
Citations number
51
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
OBJECTIVE - To determine 1) if there was a differential effect of glyc
emic control on individual counterregulatory hormone responses to hypo
glycemia in patients with insulin-dependent diabetes mellitus (IDDM),
2) whether these modifications affect hypoglycemic symptom perception,
and 3) if there was a level of glycemic control below which counterre
gulatory and symptomatic responses to hypoglycemia become consistently
altered. RESEARCH DESIGN AND METHODS - We performed hypoglycemic clam
p studies on 38 patients with IDDM and 38 healthy control subjects. Gl
ucose was lowered from 5.0 to 2.2 mmol/l over 3 h in decrements of 0.6
mmol/l each 30 min. Epinephrine, cortisol, growth hormone (GH), gluca
gon, and symptom score were measured at each glucose plateau. RESULTS
- In IDDM patients, HbA(1) levels were positively correlated with incr
emental epinephrine (r = 0.58, P < 0.001) and cortisol (r = 0.52, P <
0.01)responses, but inversely correlated with GH responses (r = -0.31,
P < 0.05). The increase in symptom score correlated with the epinephr
ine response in the IDDM patients (r = 0.57, P < 0.001), but not in th
e healthy control subjects (r = -0.02, NS). In IDDM patients with HbA(
1) less than or equal to 7.8% (n = 7), the epinephrine, cortisol, and
symptomatic responses to hypoglycemia were blunted, but GH secretion w
as preserved. CONCLUSIONS - These data suggest that 1) there is differ
ential regulation of counterregulatory hormone secretion that is depen
dent on the level of glycemic control, 2) epinephrine is an important
determinant of symptom perception in IDDM patients, but not in healthy
control subjects, and 3) multiple defects in counterregulatory hormon
e secretion and symptom perception are consistently observed in patien
ts with HbA, levels less than or equal to 7.8%.