Compromised Hormonal Counterregulation, Symptom Awareness, and Neurophysiological Function After Recurrent Short-Term Episodes of Insulin-Induced Hypoglycemia in IDDM Patients
| Autor: | Walter Renn, Rainer Kaschel, Ulrich W Buettner, M. Eggstein, Thomas Lingenfelser, Matthias F Jung, Heike Zaiser-Kaschel, B. Jakober, Ute Sommerwerck |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Epinephrine Hydrocortisone Endocrinology Diabetes and Metabolism medicine.medical_treatment Sweating Hypoglycemia Autonomic Nervous System Adrenocorticotropic Hormone Internal medicine Immunopathology Internal Medicine medicine Homeostasis Humans Insulin Pancreatic hormone Glycemic Autoimmune disease business.industry Awareness medicine.disease Hormones Diabetes Mellitus Type 1 Clamp Endocrinology Growth Hormone Evoked Potentials Auditory Female business Hormone |
| Zdroj: | Diabetes. 42:610-618 |
| ISSN: | 1939-327X 0012-1797 |
| DOI: | 10.2337/diab.42.4.610 |
| Popis: | To test the hypothesis that recurrent short-term hypoglycemic episodes may impair hormonal counterregulation, symptom awareness, and neurophysiological function during subsequent hypoglycemia, we examined two groups of IDDM patients (n = 18), neither of whom exhibited signs of autonomic neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed three days apart with stable glycemic plateaus of 5.6, 3.3, 2.2, and 1.7 mM, at which the patients' awareness of and response to hypoglycemia was evaluated. In the intervention group (n = 11), three short-term hypoglycemic episodes preceded the second clamp study. Counterregulatory hormones increased significantly during hypoglycemia, but adrenaline (P < 0.03), cortisol (P < 0.01), and ACTH (albeit not significant) showed a blunted response after repetitive hypoglycemic events. In this group, the perception of hypoglycemic symptoms was significantly reduced and was most evident for the autonomic symptoms of sweating (P < 0.05), heart pounding (P < 0.01), and warmness (P < 0.03). The deterioration of neurophysiological function, as assessed from the middle latency auditory evoked potentials, was more pronounced in the intervention group (latency shift of the Pa component, P < 0.05). These data suggest that alterations of neuroendocrine counterregulation, symptom perception, and certain aspects of cerebral function may occur as a consequence of recurrent short-term hypoglycemic episodes. These adaptation phenomena may contribute to the increased incidence of severe hypoglycemia in IDDM patients on intensive insulin therapy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|