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Sexual Dimorphism in Counterregulatory Responses to Hypoglycemia after Antecedent Exercise

Departments of Medicine and Molecular Physiology and Biophysics, Vanderbilt University School of Medicine and Nashville Veteran Affairs Medical Center, Nashville, Tennessee 37232-6303

Address all correspondence and requests for reprints to: Pietro Galassetti, M.D., Ph.D., 712 MRB II, Division of Diabetes and Endocrinology, Vanderbilt University Medical School, Nashville, Tennessee 37232-6303.

Abstract

After antecedent hypoglycemia, counterregulatory responses to subsequent hypoglycemia exhibit greater blunting in men than in women. Because physical exercise and hypoglycemia share multiple counterregulatory mechanisms, we hypothesized that prior exercise may also result in gender-specific blunting of counterregulatory responses to subsequent hypoglycemia. Thirty healthy subjects (15 women and 15 men; age, 28 ± 3 yr; body mass index, 23 ± 1 kg/m²) were studied during 2-d experiments. Day 1 consisted of either identical 90-min morning and afternoon cycle exercise at 50% maximum oxygen expenditure or two 2-h episodes of hyperinsulinemic euglycemia. Day 2 consisted of a 2-h morning hyperinsulinemic-hypoglycemic clamp. Endogenous glucose production was measured using [3-³H]glucose. Muscle sympathetic nerve activity was measured using microneurography. Day 2 insulin (540 ± 36 pmol/liter) and plasma glucose (2.9 ± 0.06 pmol/liter) levels were similar in men and women during the last 30 min of hypoglycemia. Compared with antecedent euglycemia, d 1 exercise produced significant blunting of d 2 counterregulatory responses to hypoglycemia. Several key d 2 counterregulatory responses were blunted to a greater extent in men than in women: glucagon (men, -105 ± 14; women, -25 ± 7 ng/liter; P < 0.0001), epinephrine (men, -2625 ± 257 pmol/liter; women, -212 ± 573; P < 0.001), norepinephrine (men, -0.50 ± 0.12 nmol/liter; women, -0 ± 0.11; P < 0.001), and muscle sympathetic nerve activity (men, -13 ± 4; women, -4 ± 4 bursts/min; P < 0.01). Cardiovascular responses (heart rate and systolic and mean arterial blood pressures) were also more blunted by antecedent exercise in men than in women. After d 1 exercise, the amount of glucose infused during d 2 hypoglycemia in men was increased 6-fold compared with that after d 1 euglycemia. This amount was significantly increased (P < 0.01) compared with the 2-fold (P < 0.01) increment in glucose infusion that was required in women after d 1 exercise. Lipolysis was unaffected by d 1 exercise in women, but was significantly blunted during d 2 hypoglycemia in men. In summary, two bouts of prolonged, moderate exercise (90 min at 50% maximum oxygen expenditure) induced a marked sexual dimorphism in key neuroendocrine (glucagon, catecholamines, and muscle sympathetic nerve activity) and metabolic (glucose kinetic, lipolysis) responses to next day hypoglycemia.

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