We hypothesized, first, that recent antecedent hypoglycemia causes reduced autonomic responses to subsequent hypoglycemia in patients with well-controlled insulin-dependent diabetes mellitus (IDDM) and that the reduced responses are specific for the stimulus of hypoglycemia while the responses to other stimuli are unaltered and, second, that reduced autonomic responses, specifically sympathochromaffin, so-induced are not simply the result of prior activation of the system. To test the first hypothesis, eight patients with IDDM, selected for HbA1c levels < 8.0% and the absence of classic diabetic autonomic neuropathy, were studied twice. On one occasion, clamped hypoglycemia (∼ 2.8 mM) was produced at 1400–1600 on days 2 and 3; on the other occasion clamped euglycemia (∼ 5.6 mM) was produced at those times. On both occasions, autonomic responses to hypoglycemia (∼ 2.8 mM) were determined the morning of day 3 and those to standing, exercise, and a formula meal the morning of day 4. Following afternoon hypoglycemia, 1) the adrenomedullary epinephrine (EPI) response to hypoglycemia was reduced (P = 0.0397) but that to standing, exercise, and a meal were unaltered; 2) the sympathetic neural norepinephrine (NE) response to standing and to exercise was unaltered; and 3) the partially parasympathetic neural-mediated pancreatic polypeptide response to a meal was unaltered. To test the second hypothesis, seven nondiabetic subjects were studied twice, once with cycle exercise (60% peak VO2 × 60 min) and once without exercise 90 min before clamped hypoglycemia (∼ 2.8 mM). Prior exercise had no effect on the EPI, NE, or pancreatic polypeptide responses to hypoglycemia. We conclude, first, that the phenomenon of hypoglycemia-associated autonomic failure can be induced in patients with well-controlled IDDM and is specific for the stimulus of hypoglycemia and, second, that this is not simply the result of prior activation of the system.
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Original Articles|
June 01 1994
Hypoglycemia-Induced Autonomic Failure in IDDM is Specific for Stimulus of Hypoglycemia and Is Not Attributable to Prior Autonomic Activation
Chatchalit Rattarasarn;
Chatchalit Rattarasarn
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and the General Clinical Research Center and the Diabetes Research and Training Center, Washington University School of Medicine
St. Louis, Missouri
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Samuel Dagogo-Jack;
Samuel Dagogo-Jack
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and the General Clinical Research Center and the Diabetes Research and Training Center, Washington University School of Medicine
St. Louis, Missouri
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Jeffery J Zachwieja;
Jeffery J Zachwieja
Section of Applied Physiology, Department of Medicine, and the General Clinical Research Center and the Diabetes Research and Training Center, Washington University School of Medicine
St. Louis, Missouri
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Philip E Cryer
Philip E Cryer
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and the General Clinical Research Center and the Diabetes Research and Training Center, Washington University School of Medicine
St. Louis, Missouri
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Address correspondence and reprint requests to Dr. Philip E. Cryer, Division of Endocrinology, Diabetes and Metabolism (Box 8127), Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110.
Diabetes 1994;43(6):809–818
Article history
Received:
September 27 1993
Revision Received:
February 08 1994
Accepted:
February 08 1994
PubMed:
8194668
Citation
Chatchalit Rattarasarn, Samuel Dagogo-Jack, Jeffery J Zachwieja, Philip E Cryer; Hypoglycemia-Induced Autonomic Failure in IDDM is Specific for Stimulus of Hypoglycemia and Is Not Attributable to Prior Autonomic Activation. Diabetes 1 June 1994; 43 (6): 809–818. https://doi.org/10.2337/diab.43.6.809
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