Hypoglycemia has been incriminated as a possible factor responsible for development of the hypoglycemia unawareness phenomenon in patients with type I diabetes. Many patients with this condition, however, do not have a history of recent hypoglycemia. Because asymptomatic nocturnal hypoglycemia commonly occurs in type I diabetes, we tested the hypothesis that such episodes might be capable of inducing this phenomenon. Accordingly, autonomic and neuroglycopenic symptoms, counterregulatory hormone responses, and cognitive function were assessed during standardized insulin-induced hypoglycemia in 10 normal volunteer subjects on two occasions—once after induction of asymptomatic nocturnal hypoglycemia and once after control studies in which saline rather than insulin was infused overnight. Compared with control experiments, asymptomatic nocturnal hypoglycemia increased the threshold (required greater hypoglycemia for initiation) and reduced the magnitude of autonomic and neuroglycopenic symptoms, counterregulatory hormone responses, and cognitive dysfunction during subsequent hypoglycemia (all, P < 0.05). These results indicate that asymptomatic hypoglycemia may induce hypoglycemia unawareness and, thus, may explain why not every patient with this condition has a history of prior hypoglycemia. Our results therefore support the concept that in type I diabetes this phenomenon may be largely attributable to antecedent hypoglycemia.
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Original Articles|
September 01 1993
Induction of Hypoglycemia Unawareness by Asymptomatic Nocturnal Hypoglycemia
Thiemo Veneman;
Thiemo Veneman
General Clinical Research Center, Department of Medicine and Physiology, University of Pittsburgh
Pittsburgh, Pennsylvania
Department of Medicine, Washington University, School of Medicine
St. Louis, Missouri
The Whittier Institute for Diabetes and Endocrinology
LaJolla, California
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Asimina Mitrakou;
Asimina Mitrakou
General Clinical Research Center, Department of Medicine and Physiology, University of Pittsburgh
Pittsburgh, Pennsylvania
Department of Medicine, Washington University, School of Medicine
St. Louis, Missouri
The Whittier Institute for Diabetes and Endocrinology
LaJolla, California
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Marian Mokan;
Marian Mokan
General Clinical Research Center, Department of Medicine and Physiology, University of Pittsburgh
Pittsburgh, Pennsylvania
Department of Medicine, Washington University, School of Medicine
St. Louis, Missouri
The Whittier Institute for Diabetes and Endocrinology
LaJolla, California
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Philip Cryer;
Philip Cryer
General Clinical Research Center, Department of Medicine and Physiology, University of Pittsburgh
Pittsburgh, Pennsylvania
Department of Medicine, Washington University, School of Medicine
St. Louis, Missouri
The Whittier Institute for Diabetes and Endocrinology
LaJolla, California
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John Gerich
John Gerich
General Clinical Research Center, Department of Medicine and Physiology, University of Pittsburgh
Pittsburgh, Pennsylvania
Department of Medicine, Washington University, School of Medicine
St. Louis, Missouri
The Whittier Institute for Diabetes and Endocrinology
LaJolla, California
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Address correspondence and reprint requests to Dr. John E. Gerich, The Whittier Institute for Diabetes and Endocrinology, 9894 Genesee Avenue, LaJolla, CA 92037.
Diabetes 1993;42(9):1233–1237
Article history
Received:
December 28 1992
Revision Received:
April 19 1993
Accepted:
April 19 1993
PubMed:
8349033
Citation
Thiemo Veneman, Asimina Mitrakou, Marian Mokan, Philip Cryer, John Gerich; Induction of Hypoglycemia Unawareness by Asymptomatic Nocturnal Hypoglycemia. Diabetes 1 September 1993; 42 (9): 1233–1237. https://doi.org/10.2337/diab.42.9.1233
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