Key result
Antecedent hypoglycemia reduces peak norepinephrine response to subsequent hypoglycemia by ~29% versus antecedent euglycemia.
Why the study?
The duration of the effect of short-term antecedent hypoglycemia on physiological responses to subsequent hypoglycemia in patients with IDDM was unclear.
Does antecedent hypoglycemia alter physiological responses to subsequent hypoglycemia 2 days later in patients with IDDM?
Does antecedent hypoglycemia alter physiological responses to subsequent hypoglycemia 2 days later in patients with IDDM?
The physiological effect of 2 hours of experimental hypoglycemia on subsequent hypoglycemic responses lasts for 1-2 days in patients with type 1 diabetes, primarily affecting norepinephrine responses.
May blunt norepinephrine responses for up to 2 days in IDDM without unawareness; leaves open clinical relevance and duration in broader populations.
OBJECTIVE: To assess the effects of short-term antecedent hypoglycemia on responses to further hypoglycemia 2 days later in patients with IDDM. RESEARCH DESIGN AND METHODS: We studied eight type I diabetic patients without hypoglycemia unawareness or autonomic neuropathy during two periods at least 4 weeks apart. On day 1, 2 h of either clamped hyperinsulinemic (60 mU.m-2.min-1) hypoglycemia at 2.8 mmol/l or euglycemia at 5.0 mmol/l were induced. Hyperinsulinemic hypoglycemia was induced 2 days later with 40 min glucose steps of 5.0, 4.0, 3.5, 3.0, and 2.5 mmol/l. Catecholamine levels and symptomatic and physiological responses were measured every 10-20 min. RESULTS: When compared with the responses measured following euglycemia, the responses of norepinephrine 2 days after hypoglycemia were reduced (peak, 1.4 +/- 0.4 [mean +/- SE] vs.1.0 +/- 0.3 nmol/l [P < 0.05]; threshold, 3.4 +/- 0.1 vs. 2.9 +/- 0.1 mmol/l glucose [P < 0.01]). The responses of epinephrine (peak, 4.0 +/- 1.4 vs. 3.5 +/- 0.8 nmol/l [P = 0.84]; threshold, 3.8 +/- 0.1 vs. 3.6 +/- 0.1 mmol/l glucose [P = 0.38]), water loss (peak, 194 +/- 34 vs. 179 +/- 47 g-1.m-2.h-1 [P = 0.73]; threshold, 2.9 +/- 0.2 vs. 2.9 +/- 0.2 mmol/l glucose [P = 0.90]), tremor (peak, 0.28 +/- 0.05 vs. 0.37 +/- 0.06 root mean square volts (RMS V) [P = 0.19]; threshold, 3.2 +/- 0.2 vs. 3.1 +/- 0.2 mmol/l glucose [P = 0.70]), total symptom scores (peak, 10.6 +/- 2.1 vs. 10.8 +/- 1.9 [P = 0.95]; threshold, 3.3 +/- 0.2 vs. 3.6 +/0 0.1 mmol/l glucose [P = 0.15]), and cognitive function (four-choice reaction time: threshold, 2.9 +/- 0.2 vs. 3.0 +/- 0.2 mmol/l glucose [P = 0.69]) were unaffected. CONCLUSIONS: The effect on hypoglycemic physiological responses of 2 h of experimental hypoglycemia lasts for 1-2 days in these patients with IDDM . The pathophysiological effect of antecedent hypoglycemia may be of shorter duration in IDDM patients, compared with nondiabetic subjects.
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George et al. (1997) studied IDDM (Type I Diabetes) (n=8). Antecedent hypoglycemia vs. Euglycemia at 5.0 mmol/l was evaluated on Peak norepinephrine response (nmol/l) (p=< 0.05). Antecedent hypoglycemia reduced the peak norepinephrine response to subsequent hypoglycemia 2 days later compared to antecedent euglycemia (1.0 vs 1.4 nmol/l; P<0.05).
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