This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fruehwald-Schultes, B. Articles by Peters, A. Search for Related Content PubMed PubMed Citation Articles by Fruehwald-Schultes, B. Articles by Peters, A.

Protective Effect of Insulin against Hypoglycemia-Associated Counterregulatory Failure

Departments of Internal Medicine I (B.F.-S., W.K., W.B., P.W., H.L.F., A.P.) and Clinical Neuroendocrinology (J.B.), University of Luebeck, D-23538 Luebeck, and the Department of Diabetes and Metabolism, Klinikum Karlsburg (W.K.), D-17495 Karlsburg, Germany

Address all correspondence and requests for reprints to: Bernd Fruehwald-Schultes, M.D., Medical University Luebeck, Department of Internal Medicine I, Ratzeburger Allee 160, D-23538 Luebeck, Germany. E-mail: fruehwal{at}kfg.mu-luebeck.de

Antecedent hypoglycemic episodes reduce the counterregulatory neuroendocrine response to hypoglycemia. The role of insulin in the mechanism responsible for the antecedent hypoglycemia causing subsequent counterregulatory failure has not been elucidated. We performed antecedent hypoglycemic clamps (56 mg/dL) lasting 2 h with differing degrees of hyperinsulinemia, which were followed by 6-h stepwise hypoglycemic clamps (76–66–56–46 mg/dL) on the next day. Experiments were carried out in 30 young, healthy men. Fifteen of these subjects were tested on 2 occasions. On 1 occasion the antecedent hypoglycemia was induced by insulin infusion at a rate of 1.5 mU/min·kg (low insulin-ante-hypo); on the other occasion the insulin infusion rate was 15.0 mU/min·kg (high insulin-ante-hypo). Both sessions were separated by at least 4 weeks, and their order was balanced across subjects. The remaining 15 subjects (control group) received the same stepwise hypoglycemic clamp as the other subjects, but without antecedent hypoglycemia. During the stepwise hypoglycemic clamp, the counterregulatory increases in ACTH, cortisol, and norepinephrine were significantly blunted after the low insulin-ante-hypo (P < 0.01, P < 0.05, and P < 0.05, respectively) but not after the high insulin-ante-hypo (P = 0.12, P = 0.92, and P = 0.19, respectively) compared to that in the control group. The cortisol, norepinephrine, and glucagon responses were greater after the high than after the low insulin-ante-hypo (all P < 0.05). In conclusion, the present study clearly demonstrates that even a single episode of mild hypoglycemia reduces neuroendocrine counterregulation 18–24 h later. Insulin has a moderate protective effect on subsequent counterregulation.

This article has been cited by other articles:

				D. A. Sandoval, L. Ping, A. R. Neill, S. Morrey, and S. N. Davis Cortisol Acts Through Central Mechanisms to Blunt Counterregulatory Responses to Hypoglycemia in Conscious Rats Diabetes, September 1, 2003; 52(9): 2198 - 2204. [Abstract] [Full Text] [PDF]

				B. Schultes, K. M. Oltmanns, W. Kern, H. L. Fehm, J. Born, and A. Peters Modulation of Hunger by Plasma Glucose and Metformin J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1133 - 1141. [Abstract] [Full Text] [PDF]

				E. M. Bingham, D. Hopkins, D. Smith, A. Pernet, W. Hallett, L. Reed, P. K. Marsden, and S. A. Amiel The Role of Insulin in Human Brain Glucose Metabolism: An 18Fluoro-Deoxyglucose Positron Emission Tomography Study Diabetes, December 1, 2002; 51(12): 3384 - 3390. [Abstract] [Full Text] [PDF]

				B. Fruehwald-Schultes, W. Kern, K. M. Oltmanns, S. Sopke, B. Toschek, J. Born, H. L. Fehm, and A. Peters Metformin Does Not Adversely Affect Hormonal and Symptomatic Responses to Recurrent Hypoglycemia J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4187 - 4192. [Abstract] [Full Text] [PDF]

				B. Fruehwald-Schultes, W. Kern, W. Bong, P. Wellhoener, W. Kerner, J. Born, H. L. Fehm, and A. Peters Supraphysiological Hyperinsulinemia Acutely Increases Hypothalamic-Pituitary-Adrenal Secretory Activity in Humans J. Clin. Endocrinol. Metab., September 1, 1999; 84(9): 3041 - 3046. [Abstract] [Full Text]