Meticulous Prevention of Hypoglycemia Normalizes the Glycemic Thresholds and Magnitude of Most of Neuroendocrine Responses to, Symptoms of, and Cognitive Function During Hypoglycemia in Intensively Treated Patients With Short-Term IDDM
| Autor: | Francesco Modarelli, M. Ciofetta, Scionti L, P. Bottini, Carmine G. Fanelli, Lucilla Epifano, Fausto Santeusanio, Aanna Maria Rambotti, B Bolli Geremia, S. Pampanelli, Paolo Brunetti, Francesca Porcellati, Bruno Annibale, Antonio Di Vincenzo, M. Lepore |
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| Rok vydání: | 1993 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Pediatrics Time Factors Epinephrine endocrine system diseases Endocrinology Diabetes and Metabolism Hypoglycemia Norepinephrine Cognition Hyperinsulinism Diabetes mellitus Internal medicine Immunopathology Internal Medicine medicine Humans Insulin Glycemic Glycated Hemoglobin Hypoglycemia unawareness Autoimmune disease Insulin blood business.industry nutritional and metabolic diseases Awareness Glucagon medicine.disease Diabetes Mellitus Type 1 Endocrinology Female business |
| Zdroj: | Diabetes. 42:1683-1689 |
| ISSN: | 1939-327X 0012-1797 |
| Popis: | To test the hypothesis that hypoglycemia unawareness is largely secondary to recurrent therapeutic hypoglycemia in IDDM, we assessed neuroendocrine and symptom responses and cognitive function in 8 patients with short-term IDDM (7 yr) and hypoglycemia unawareness. Patients were assessed during a stepped hypoglycemic clamp, before and after 2 wk and 3 mo of meticulous prevention of hypoglycemia, which resulted in a decreased frequency of hypoglycemia (0.49 ± 0.05 to 0.045 ± 0.03 episodes/patient-day) and an increase in HbA1c (5.8 ± 0.3 to 6.9 ± 0.2%) (P < 0.05). We also studied 12 nondiabetic volunteer subjects. At baseline, lower than normal symptom and neuroendocrine responses occurred at lower than normal plasma glucose, and cognitive function deteriorated only marginally during hypoglycemia. After 2 wk of hypoglycemia prevention, the magnitude of symptom and neuroendocrine responses (with the exception of glucagon and norepinephrine) nearly normalized, and cognitive function deteriorated at the same glycemic threshold and to the same extent as in nondiabetic volunteer subjects. At 3 mo, the glycemic thresholds of symptom and neuroendocrine responses normalized, and surprisingly, some of the responses of glucagon recovered. We concluded that hypoglycemia unawareness in IDDM is largely reversible and that intensive insulin therapy and a program of intensive education may substantially prevent hypoglycemia and at the same time maintain the glycemic targets of intensive insulin therapy, at least in patients with IDDM of short duration. |
| Databáze: | OpenAIRE |
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