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Original Articles

Intermittent Hypoglycemia Impairs Glucose Counterregulation

  1. Barbara Widom and
  2. Donald C Simonson
  1. Department of Internal Medicine, Joslin Diabetes Center; and the New England Deaconess Hospital and Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
  1. Address correspondence and reprint requests to Donald C. Simonson, MD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.
Diabetes 1992 Dec; 41(12): 1597-1602. https://doi.org/10.2337/diab.41.12.1597
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Abstract

IDDM patients who maintain strict glycemic control have impaired counterregulatory hormone and symptomatic responses to hypoglycemia. To test the hypothesis that intermittent exposure to hypoglycemia plays an etiological role in these defective responses, we produced 4 consecutive daily episodes of hypoglycemia in 10 healthy, nondiabetic volunteers by using the insulin clamp technique. Fasting (5.3 ± 0.1 vs. 5.4 ± 0.1 mM) and nadir (2.3 ± 0.1 vs. 2.4 ± 0.1 mM) glucose levels achieved during insulin infusion did not differ on study days 1 and 4. In contrast, the glucose levels required to stimulate an increase in EPI (2.8 vs. 3.1 mM), glucagon (2.8 vs. 3.2 mM), cortisol (2.4 vs. 2.9 mM), GH (2.6 vs. 3.0 mM), and autonomic hypoglycemic symptoms (2.2 vs. 2.5 mM) were all significantly lower on study day 4 versus study day 1 (P < 0.005–0.05). Basal levels of EPI and cortisol, but not glucagon, GH, or NE also were reduced on the final study day. We conclude that intermittent hypoglycemia can result in attenuation of the hormonal and symptomatic responses to insulin-induced hypoglycemia and may contribute to the defective counterregulatory responses in patients with well-controlled IDDM.

  • Received November 14, 1991.
  • Revision received July 2, 1992.
  • Accepted July 2, 1992.
  • Copyright © 1992 by the American Diabetes Association

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December 1992, 41(12)
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Intermittent Hypoglycemia Impairs Glucose Counterregulation
Barbara Widom, Donald C Simonson
Diabetes Dec 1992, 41 (12) 1597-1602; DOI: 10.2337/diab.41.12.1597

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Intermittent Hypoglycemia Impairs Glucose Counterregulation
Barbara Widom, Donald C Simonson
Diabetes Dec 1992, 41 (12) 1597-1602; DOI: 10.2337/diab.41.12.1597
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