Visual Abstract

The mechanism by which recurrent hypoglycemia (RH) impairs the sympathoadrenal response to hypoglycemia remains unknown. To explore altered brain dopaminergic signaling as a mechanism, 10 weeks old rats were randomized to 3 days: 1) recurrent saline (RS), 2) insulin (2-1.2 U/kg, sc) induced RH (25-50 mg/dl), or 3) RH + antecedent dopamine receptor antagonist metoclopramide (MET, 3 mg/kg, ip). qPCR of brain biopsies demonstrated RH downregulated dopaminergic signaling, noted by decreased expression of dopamine D2 receptor (Drd2, 52%*) and increased dopamine transporter (DAT, ~1.9-fold*) in the ventral tegmental area (VTA); an effect prevented by MET (Figure 1A). To test whether recurrent dopamine activation in the VTA is sufficient to impair the sympathoadrenal response to hypoglycemia, a second rat cohort was randomized to 3-day recurrent VTA infusion of: 1) aCSF (control), or 2) Drd2 agonist bromocriptine (Bromo; 5 µg/d). During hyperinsulinemic (20 mU/kg/min) hypoglycemic (∼45 mg/dl) clamps, recurrent Bromo resulted in an increased glucose infusion rate (1.7-fold*) and blunted epinephrine response (~50%*, Figure 1B). These results demonstrate that blunted dopaminergic signaling in the VTA induced by RH contributes to the impaired sympathoadrenal response, which may be associated with recurrent brain dopaminergic activation. *p<0.05.


R. Agrawal: None. S. Sharma: None. S. Fisher: None.


National Institutes of Health (R01NS070235-01A1, R01DK118082)

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