Antecedent adrenaline attenuates the responsiveness to but not the release of counterregulatory hormones during subsequent hypoglycemia.

Abstract

Hypoglycemia unawareness is thought to be the consequence of recurrent hypoglycemia, yet the underlying mechanism is still incompletely understood. The aim of the present study was to determine the role of antecedent elevated adrenaline in the pathogenesis of hypoglycemia unawareness. Sixteen healthy volunteers (eight of either sex) participated in two experiments, performed in random order and at least 3 wk apart. During the morning, three consecutive doses of 0.04, 0.06, and 0.08 microg.kg(-1).min(-1) of adrenaline or matching placebo (normal saline) were infused for the total duration of 1 h. Three hours later, a hyperinsulinemic (360 pmol.m(-2).min(-1)) two-step hypoglycemic (5.0-3.5-2.5 mmol.liter(-1)) clamp study was performed. During hypoglycemia, hypoglycemic symptoms, counterregulatory hormones, cardiovascular responses, and cognitive function were monitored. Hypoglycemia induced similar responses of autonomic and neuroglycopenic symptoms, counterregulatory hormones, and lengthening in reaction time on the choice reaction time task, irrespective of antecedent infusions. However, prior adrenaline was associated with higher exogenous glucose requirements at hypoglycemic nadir (10.1 +/- 1.3 vs. 7.3 +/- 1.3 micromol.kg(-1).min(-1), P = 0.017), an attenuated hypoglycemia-induced fall in blood pressure (mean arterial pressure, -13 +/- 2 vs. -8 +/- 2 mm Hg, P = 0.006), and preserved cognitive function as assessed by the symbol digit test during hypoglycemia, when compared with prior placebo. We conclude that elevated adrenaline attenuates the responsiveness to, but not the release of counterregulatory hormones during subsequent hypoglycemia. As such, adrenaline's role in the development of hypoglycemia unawareness is limited.

• Authors: Bastiaan E de Galan, Saskia J Rietjens, Cees J Tack, Sieberen P van der Werf, C G J Sweep, Jacques W M Lenders, Paul Smits
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 88 Issue 11 Pg. 5462-7 (Nov 2003) ISSN: 0021-972X [Print] United States
• PMID: 14602790 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic Agonists
• Blood Glucose
• Insulin
• Epinephrine

Topics

• Adrenergic Agonists (administration & dosage, metabolism)
• Adult
• Awareness (physiology)
• Blood Glucose
• Down-Regulation (drug effects)
• Epinephrine (administration & dosage, metabolism)
• Female
• Humans
• Hyperinsulinism (metabolism, physiopathology)
• Hypoglycemia (metabolism, physiopathology, psychology)
• Insulin (blood)
• Male
• Perception (physiology)