Summary
We were interested in studying whether impaired hypoglycemic awareness after intensified insulin treatment with insulin pumps is associated with impaired glucose counterregulation. Glucose counterregulatory hormones were measured in 7 type I diabetic patients with altered symptoms after 6 months of continuous subcutaneous insulin infusion (CSII) (group 1) and in 9 patients with unchanged symptoms of hypoglycemia under CSII (group 2). The groups did not differ in diabetic control, duration of diabetes, or prevalence of neuropathy. Counterregulatory hormone response to an insulin-induced episode of hypoglycemia was measured before (first test) and after 6 months (second test) of CSII. Glucose nadirs and glucose recovery were similar in both groups and both tests. The mean plasma glucagon values demonstrate a lack of glucagon response in both groups and both tests. Growth hormone and cortisol increased in both groups and both tests without any difference between the groups or first and second tests. Epinephrine response was similar in both tests of group 2 (first test: 50±5 to 416±73; second test; 45±5 to 456 pg/ml), while in group 1 the response was not increased significantly in the second test [first test: 32± 6 to 346± 63; second test: 44± 7 to 575± 91 pg/ml; areas under curve (AUC) 11977 and 16345 pg×ml−1×90 min−1 (p= 0.36)]. There was a norepinephrine response in both groups and both tests, with nonsignificantly higher plasma levels during the second test [AUC in pg×ml−1×90 min−1; group 1, first test: 20954, second test: 26675 (p=0.394); group 2, first test: 20745, second test: 27089 (p=0.302)]. The results demonstrate that impaired awareness of hypoglycemic symptoms after intensified insulin therapy is not associated with impaired glucose recovery of hypoglycemia or impaired response of glucose counterregulatory hormones. Further-more, we found that the frequency of glucopenic symptoms reported by the patients during everyday life increased after CSII, while adrenergic symptoms were less frequent.
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Abbreviations
- CSII:
-
continuous subcutaneous insulin infusion
- AUC:
-
area under curve
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Hübinger, A., Wiefels, K., Ziegler, D. et al. Glucose counterregulation in type 1 diabetic patients with decreased symptoms of hypoglycemia after insulin pump treatment. Klin Wochenschr 69, 802–807 (1991). https://doi.org/10.1007/BF01744273
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DOI: https://doi.org/10.1007/BF01744273