COUNTERREGULATORY HORMONES IN INSULIN-TREATED DIABETIC-PATIENTS ADMITTED TO AN ACCIDENT AND EMERGENCY DEPARTMENT WITH HYPOGLYCEMIA

The aim of the study was (1) to describe hormone responses in insulin- induced hypoglycaemia and (2) to investigate if a combined treatment w ith intravenous glucose and intramuscular glucagon (group A) would imp rove glucose recovery as compared to treatment with intravenous glucos e alone (group B). Eighteen adult patients with insulin-treated diabet es mellitus admitted to the Accident and Emergency Department with hyp oglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and coun terregulatory hormones were measured before and 30-120 min after treat ment. Pre-treatment counterregulatory hormone concentrations were sign ificantly lower than hormone concentrations during induced hypoglycaem ia in healthy control subjects but significantly higher than healthy f asting concentrations for plasma adrenaline (p = 0.020), glucagon (p = 0.008), growth hormone (p = 0.011), and cortisol (p<0.00001). Thus, a lthough glucagon and adrenaline responses may be absent when studying Type 1 diabetic patients in the experimental setting, both hormones in crease to a significant extent in 'real-life' hypoglycaemia in this pa tient group, although to a lesser degree than might be expected. Plasm a glucose did not differ significantly between the two treatments at a ny time point. Despite access to food, one of four patients in group B and one of five patients in group A had plasma glucose below 4.0 mmol l(-1) after 120 min. In conclusion, low yet significantly elevated co ncentrations of adrenaline and glucagon were found in diabetic patient s admitted with severe hypoglycaemia to an Accident and Emergency Depa rtment. (C) 1998 by John Wiley & Sons, Ltd.