Rate of Glucose Fall Does Not Affect Counterregulatory Hormone Responses to Hypoglycemia in Normal and Diabetic Humans

To test the hypothesis that variations in rate of glucose fall influence counterregulatory hormone responses to hypoglycemia, we have modified the glucose-clamp technique to provide a reproducible hypoglycemic stimulus in normal and type I diabetic subjects that varied only in the rate of glucose fall. Responsive elevations in plasma epinephrine and norepinephrine and in growth hormone, glucagon, and cortisol were not significantly affected by a ninefold change in the rate at which plasma glucose was lowered from 83 ± 1 to 50 ± 1 mg/dl in normal subjects. Similarly, wide variation in the rate of fall produced no substantive differences in counterregulatory hormone responses to hypoglycemia in diabetic subjects. The plasma glucose threshold at which epinephrine release began, determined from the slow-fall studies, was 63 ± 3 mg/dl in normal subjects but exhibited a wide range (48-74 mg/dl). Similar values were found in the diabetics. Thresholds for growth hormone, cortisol, and glucagon were slightly lower, ranging from 45 to 68 mg/dl in the normals. Our data suggest that counterregulatory hormone responses to hypoglycemia are triggered by the glucose level per se and not by its rate of fall. Furthermore, individual differences in glucose thresholds for epinephrine release may contribute to variations in the glucose level associated with hypoglycemic symptoms.