DECREASED EPINEPHRINE RESPONSES TO HYPOGLYCEMIA DURING SLEEP

Citation
Tw. Jones et al., DECREASED EPINEPHRINE RESPONSES TO HYPOGLYCEMIA DURING SLEEP, The New England journal of medicine, 338(23), 1998, pp. 1657-1662
Citations number
20
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00284793
Volume
338
Issue
23
Year of publication
1998
Pages
1657 - 1662
Database
ISI
SICI code
0028-4793(1998)338:23<1657:DERTHD>2.0.ZU;2-7
Abstract
Background In patients with type I diabetes mellitus, hypoglycemia occ urs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregula tory-hormone responses to hypoglycemia. Methods We studied the counter regulatory-hormone responses to insulin-induced hypoglycemia in eight adolescent patients with type I diabetes and six age-matched normal su bjects when they were awake during the day, asleep at night, and awake at night. In each study, the plasma glucose concentration was stabili zed for 60 minutes at approximately 100 mg per deciliter (5.6 mmol per liter) and then reduced to 50 mg per deciliter (2.8 mmol per liter) a nd maintained at that concentration for 40 minutes. Plasma free insuli n, epinephrine, norepinephrine, cortisol, and growth hormone were meas ured frequently during each study. Sleep was monitored by polysomnogra phy. Results The plasma glucose and free insulin concentrations were s imilar in both groups during all studies. During the studies when the subjects were asleep, no one was awakened during the hypoglycemic phas e, but during the final 30 minutes of the studies when the subjects we re awake both the patients with diabetes and the normal subjects had s ymptoms of hypoglycemia. In the patients with diabetes, plasma epineph rine responses to hypoglycemia were blunted when they were asleep (mea n [+/-SE] peak plasma epinephrine concentration, 70+/-14 pg per millil iter [382+/-76 pmol per liter]; P=0.3 for the comparison with base lin e), as compared with when they were awake during the day or night (238 +/-39 pg per milliliter [1299+/-213 pmol per liter], P=0.004 for the c omparison with base line, and 296+/-60 pg per milliliter [1616+/-327 p mol per liter], P=0.004, respectively). The patients' plasma norepinep hrine responses were also reduced during sleep, whereas their plasma c ortisol concentrations did not increase and their plasma growth hormon e concentrations increased, slightly. The patterns of counterregulator y-hormone responses in the normal subjects were similar. Conclusions S leep impairs counterregulatory-hormone responses to hypoglycemia in pa tients with diabetes and normal subject. (C) 1998, Massachusetts Medic al Society.