+ Site Statistics
References:
52,654,530
Abstracts:
29,560,856
PMIDs:
28,072,755
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Effect of glycemic control on glucose counterregulation during hypoglycemia in NIDDM



Effect of glycemic control on glucose counterregulation during hypoglycemia in NIDDM



Diabetes Care 21(8): 1330-1338



We examined the effect of glycemic control of NIDDM on counterregulatory hormone responses to hypoglycemia and compared the effect with that seen in patients with IDDM. Eleven subjects with NIDDM and eight age- and weight-matched control subjects and ten subjects with IDDM and ten age- and weight-matched control subjects were studied. All subjects underwent a stepped hypoglycemic-hyper-insulinemic clamp study during which plasma glucose levels were lowered in a stepwise manner from 5.0 to 2.2 mmol/l in steps of 0.6 mmol/l every 30 min. Counterregulatory hormones (epinephrine, norepinephrine, glucagon, ACTH, cortisol, and growth hormone [GH]) were measured, and a symptom survey was administered during the last 10 min of each 30-min interval. The threshold for release of epinephrine, norepinephrine, ACTH, and cortisol occurred at higher plasma glucose levels in NIDDM than in IDDM patients (P < 0.05-0.01). The glucose threshold for release of epinephrine and norepinephrine correlated with glycemic control as measured by glycosylated hemoglobin (P < 0.05-0.01). However, for a given level of glycemic control, the threshold for release of epinephrine and norepinephrine occurred at a higher glucose level in NIDDM versus IDDM patients (P < 0.05-0.01). At the nadir level of hypoglycemia, glucagon, ACTH, and cortisol levels were all higher in NIDDM compared with IDDM subjects, whereas GH levels were lower. Glycemic control alters counterregulatory responses to hypoglycemia in NIDDM as has been previously reported in IDDM. However, at similar levels of glycemic control, NIDDM patients release counterregulatory hormones at a higher plasma glucose level than patients with IDDM. In addition, subjects with NIDDM maintain their glucagon response to hypoglycemia. These data suggest that patients with NIDDM may be at reduced risk of severe hypoglycemia when compared with a group of IDDM patients in similar glycemic control, thus providing a more favorable risk-benefit ratio for intensive diabetes therapy in NIDDM.

(PDF emailed within 0-6 h: $19.90)

Accession: 015605636

Download citation: RISBibTeXText

PMID: 9702443

DOI: 10.2337/diacare.21.8.1330


Related references

Glycemic control, awareness of, and counterregulation to, hypoglycemia, in the second decade of intensive treatment of T1DM. Diabetologia 45(Supplement 2): A 268, August, 2002

Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. New England Journal of Medicine 316(22): 1376-1383, 1987

Multifactorial origin of hypoglycemic symptom unawareness in IDDM. Association with defective glucose counterregulation and better glycemic control. Diabetes 40(6): 680-685, 1991

Effect of 2 weeks of theophylline on glucose counterregulation in patients with type 1 diabetes and unawareness of hypoglycemia. Clinical Pharmacology and Therapeutics 74(1): 77-84, 2003

Effect of intravenous infusion of exenatide (synthetic exendin-4) on glucose-dependent insulin secretion and counterregulation during hypoglycemia. Diabetes 53(9): 2397-2403, 2004

Glucose counterregulation in the elderly patient with NIDDM. Clinical & Investigative Medicine 17(4 SUPPL ): B37, 1994

Continuous glucose monitors: use of waveform versus glycemic values in the improvements of glucose control, quality of life, and fear of hypoglycemia. Journal of Diabetes Science and Technology 8(3): 488-493, 2015

Effects of long-term optimization and short-term deterioration of glycemic control on glucose counterregulation in type I diabetes mellitus. Diabetes 33(4): 394-400, 1984

Glycosylated hemoglobin and fasting plasma glucose in the assessment of outpatient glycemic control in NIDDM. Diabetes Care 5(6): 592-599, 1982

Physiology of glucose counterregulation to hypoglycemia. Endocrinology and Metabolism Clinics of North America 28(3): 467-93, V, 1999

Mechanisms of postprandial glucose counterregulation in man. Physiologic roles of glucagon and epinephrine vis-a-vis insulin in the prevention of hypoglycemia late after glucose ingestion. Journal of Clinical Investigation 72(1): 278-286, 1983

Intermittent hypoglycemia impairs glucose counterregulation. Diabetes 41(12): 1597-1602, 1992

Important role of adrenergic mechanisms in acute glucose counterregulation following insulin-induced hypoglycemia in type I diabetes. Evidence for an effect mediated by beta-adrenoreceptors. Diabetes 31(7): 641-647, 1982

Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. Journal of Clinical Investigation 64(1): 62-71, 1979