Key result
Peripheral autonomic neuropathy in Type 1 diabetes was associated with lower plasma adrenaline responses but did not change the glucose threshold for autonomic activation.
Why the study?
Does peripheral autonomic neuropathy alter the symptomatic, physiological, and hormonal responses to acute hypoglycaemia in patients with Type 1 diabetes?
Observational (n=16)
Does peripheral autonomic neuropathy alter the symptomatic, physiological, and hormonal responses to acute hypoglycaemia in patients with Type 1 diabetes?
Peripheral autonomic neuropathy does not appear to be the principal cause of hypoglycaemia unawareness in patients with Type 1 diabetes, as symptomatic responses to acute hypoglycaemia remain largely intact despite blunted adrenaline responses.
Answers are grounded in this paper and cite their sources.
Peripheral neuropathy blunts adrenaline responses without shifting hypoglycaemia thresholds in T1D; leaves open its role in unawareness and requires prospective confirmation.
The effects of peripheral autonomic neuropathy on the symptomatic, physiological, and hormonal responses to acute insulin‐induced hypoglycaemia were studied in two groups of patients with Type 1 diabetes, matched for age, duration of diabetes, and prevailing glycaemic control. A group of eight patients who gave a history of normal awareness of hypoglycaemia and had normal cardiovascular autonomic function tests were compared to a group of six patients who had symptoms of autonomic dysfunction and gross abnormalities of cardiovascular autonomic function tests. An additional two patients with autonomic neuropathy who also had hypoglycaemia unawareness were studied. Acute hypoglycaemia was induced by intravenous infusion of insulin (2.5 ***mU kg−1 min−1) and the onset of the acute autonomic reaction (R) was identified objectively by the sudden rise in heart rate and onset of sweating. Cognitive function and hypoglycaemia symptom scores were estimated serially, and plasma counterregulatory hormones were measured. Acute autonomic activation was observed to occur in all subjects in response to hypoglycaemia and commenced at similar venous plasma glucose concentrations in both groups (neuropathic patients: 1.6 ± 0.2 mmol I−1 vs non‐neuropathic patients 1.6 ± 0.2 mmol I−1, p = 0.9,). In the neuropathic patients plasma adrenaline responses were significantly lower at all time points from time R until time R + 30 min (MANOVA for repeated measures, F = 19.4, p < 0.001). The total autonomic symptom score at R was slightly lower in the neuropathic patients (12 (8–12) median (range)) but was not significantly different from the non‐neuropathic patients (14 (10–26), p = 0.10), and the total neuroglycopenic symptom scores were very similar (neuropathic group: 11 (6–21) vs non‐neuropathic group: 11.5 (6–22), p = 0.95). Although some of the autonomic responses were lower, but not significantly so, in the patients with autonomic neuropathy this study suggests that peripheral autonomic neuropathy is not the principal cause of hypoglycaemia unawareness in patients with Type 1 diabetes.
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Hepburn et al. (1993) conducted an observational in Type 1 diabetes with and without autonomic neuropathy (n=16). Peripheral autonomic neuropathy vs. Normal cardiovascular autonomic function was evaluated on Venous plasma glucose concentration at onset of acute autonomic reaction (p=0.9). Peripheral autonomic neuropathy in Type 1 diabetes was associated with lower plasma adrenaline responses but did not change the glucose threshold for autonomic activation.
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