The aim of our study was to investigate the mechanisms involved in hypoglycemia-induced platelet activation. Sixteen healthy male subjects received a 60-min intravenous infusion of human regular insulin at the rate of 64 mU · m−2 · min−1: throughout 150 min, we serially measured plasma concentrations of glucose, insulin, and counterregulatory hormones; platelet sensitivity to ADP, thrombin and platelet-activating factor; plasma concentrations of platelet markers for specific proteins of in vivo release reaction (β-thromboglobulin and platelet factor 4). Our study showed that insulin-induced hypoglycemia causes a significant increase in platelet sensitivity to aggregating agents in vitro and a platelet release reaction in vivo. Hypoglycemia-induced platelet activation was not correlated with plasma glucose concentrations at nadir and occurred before the increase of plasma growth hormone and cortisol.
To further elucidate the mechanisms of hypoglycemia-induced platelet activation, we incubated in vitro platelet-rich plasma (PRP) of seven fasting healthy subjects with the same concentrations of insulin, epineph-rine, glucagon, growth hormone, and cortisol measured in vivo during insulin-induced hypoglycemia. Only epinephrine was able to increase platelet sensitivity to aggregating agents. To investigate the role of α-adrenergic receptors in this phenomenon, we also studied four healthy subjects on another occasion, repeating the above-described insulin infusion together with intravenous infusion of phentolamine (–15 to + 150 min), 5 mg over 2 min followed by 500 μg/min. α-Blockade was able to suppress hypoglycemia-induced increase of platelet sensitivity to aggregating agents. A further study in vitro confirmed these results obtained in vivo, showing that incubation with phentolamine is able to inhibit the epinephrine-induced increase of platelet aggregation in response to ADP, thrombin, and platelet-activating factor.
In conclusion, insulin-induced hypoglycemia deeply influences platelet function, causing an increase of platelet sensitivity to aggregating agents in vitro and a release reaction in vivo. Through α-adrenoreceptors, epinephrine is responsible for the hypoglycemia-induced increase of platelet aggregation in response to ADP, thrombin, and platelet-activating factor.
