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The Temporal Relationship between Endogenously Secreted Stress Hormones and Metabolic Decompensation in Diabetic Man^*

DAVID S. SCHADE and R. PHILIP EATON

University of New Mexico School of Medicine, Department of Medicine, Division of Endocrinology Albuquerque, New Mexico 87131

Stress-induced diabetic ketoacidosis is characterized by an elevation in stress hormone concentration. Whether metabolic decompensation induces or results from the secretion of stresshormones has not been examined. Our study examined the temporal relationship between the onset of stress (pyrogeninduced shaking chills and fever); the elevation in stress hormone concentration; and the rise in plasma glucose,ketone bodies, and nonesterified fatty acid concentration.Insulin deficiency, which may itself induce stress hormone secretion, was prevented by the continuous infusion of insulin (0.01 U/kg.h).

Pyrogen administration induced malaise and fever in all diabetic volunteers and the rapid endogenous secretion of all stress hormones. The rise in plasma GH, catecholamines, and cortisol preceded the rise in plasma nonesterified fatty acid and ketone body concentrations by at least 30 min. The rise in plasma glucagon concentration preceded the rise in plasma glucose concentration by at least 1 h. Thus, these studies support a primary role for stress hormones in initiating metabolic decompensation in stressed diabetic man.

^* This work was supported by grants from the Clinical Research Center Program of the Division of Research Resources, NIH (RR-00997-02), The Kroc Foundation, and the NIAMD (1-R01-AM-18681-01).

Recipient of Research Career Development Award KZ4-AM-00260-02. To whom requests for reprints should be addressed.

Received June 15, 1979.

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