| Effect of hypoglycemia on beta-adrenergic sensitivity in normal and type 1 diabetic subjects. | |
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MedLine Citation:
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PMID: 9727899 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The purpose of this study was to assess the potential role of reduced tissue sensitivity to catecholamines in the pathogenesis of hypoglycemia unawareness in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: The effect of a single episode of hypoglycemia on beta-adrenergic sensitivity was studied in 10 type 1 diabetic patients with apparently normal awareness of hypoglycemia (age 29 +/- 5 years, diabetes duration 13 +/- 8 years, HbA1c 7.3 +/- 0.9%) and 10 age-matched healthy control subjects. Beta-adrenergic sensitivity was measured with the isoproterenol test after a hyperinsulinemic euglycemic clamp and after a hyperinsulinemic hypoglycemic clamp. Beta-adrenergic sensitivity was expressed as the dose of intravenous isoproterenol that increased the heart rate by 25 beats/min (IC25). RESULTS: During hypoglycemia, diabetic subjects had an impaired plasma epinephrine response compared with that of the control subjects (16.7 +/- 5.0 vs. 40.1 +/- 6.8 ng/ml, P = 0.02). In control subjects, the IC25 was lower after hypoglycemia than after euglycemia (0.83 +/- 0.22 vs. 1.13 +/- 0.21 microg, P = 0.02) indicating an increase in beta-adrenergic sensitivity. In diabetic subjects, on the other hand, the IC25 was greater after hypoglycemia than after euglycemia (1.00 +/- 0.26 vs. 0.65 +/- 0.14 microg, P = 0.04), indicating a decrease in beta-adrenergic sensitivity. CONCLUSIONS: In normal subjects, a single episode of hypoglycemia increases beta-adrenergic sensitivity. In diabetic subjects, in contrast, hypoglycemia reduces beta-adrenergic sensitivity. These results provide evidence that in type 1 diabetic patients, some maladaptation of tissue sensitivity to catecholamines contributes to the development of hypoglycemia unawareness. A unifying hypothesis is presented for the pathogenesis of hypoglycemia unawareness in type 1 diabetic patients incorporating the concepts of both a reduced catecholamine response and reduced adrenergic sensitivity |
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Authors:
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A Fritsche; M Stumvoll; M Grüb; S Sieslack; W Renn; R M Schmülling; H U Häring; J E Gerich |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Diabetes care Volume: 21 ISSN: 0149-5992 ISO Abbreviation: Diabetes Care Publication Date: 1998 Sep |
Date Detail:
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Created Date: 1998-11-19 Completed Date: 1998-11-19 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 7805975 Medline TA: Diabetes Care Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1505-10 Citation Subset: IM |
Affiliation:
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Department IV of Internal Medicine, University of Tübingen, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Agonists
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diagnostic use Adult Blood Glucose / metabolism Diabetes Mellitus, Type 1 / complications, physiopathology* Epinephrine / blood Female Glucose Clamp Technique Humans Hypoglycemia / complications, physiopathology* Insulin / blood Isoproterenol / diagnostic use Male Perception Receptors, Adrenergic, beta / physiology* |
| Grant Support | |
ID/Acronym/Agency:
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5M01-RR 00044/RR/NCRR NIH HHS; NIDDK-20411/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Agonists; 0/Blood Glucose; 0/Receptors, Adrenergic, beta; 11061-68-0/Insulin; 51-43-4/Epinephrine; 7683-59-2/Isoproterenol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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