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Hypoglycemia and the Autonomic Nervous System

  • Chapter
Diabetic Neuropathy

Part of the book series: Clinical Diabetes ((CLD))

Abstract

Widespread implementation of regimens to rigorously control blood sugar in patients with diabetes has led to an increased incidence of severe iatrogenic hypoglycemic events with substantial morbidity and mortality. Hypoglycemia provokes a sequence of counterregulatory metabolic, neural, and clinical responses. Insulin secretion decreases whereas glucagon, epinephrine, norepinephrine, pancreatic polypeptide, cortisol, and growth hormone increase. The sympathetic, parasympathetic, and sympatho-adrenal divisions of the autonomic nervous system are activated in response to the falling blood sugar. The spectrum of reduced counterregulatory hormone responses (in particular epinephrine) and decreased symptom perception of hypoglycemia because of decreased autonomic nervous system activation following recent antecedent hypoglycemia has been termed “hypoglycemia induced autonomic failure.” This leads to a vicious cycle of hypoglycemia unawareness that induces a further decrease in counterregulatory hormone responses to hypoglycemia. This vicious cycle occurs commonly in diabetic subjects in strict glycemic control. The reduced epinephrine response to antecedent hypoglycemia occurs in the absence of diabetic autonomic neuropathy as measured by standard tests of autonomic function. The presence of autonomic neuropathy, however, further attenuates the epinephrine response to hypoglycemia in diabetic subjects after recent hypoglycemic exposure. The mechanisms of hypoglycemia induced autonomic failure are not fully elucidated.

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Authors and Affiliations

  1. Autonomic Lab, Beth Israel Deaconess Medical Center, Boston, MA

    Roy Freeman MD

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  1. Roy Freeman MD
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Editors and Affiliations

  1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

    Aristidis Veves MD, DSc

  2. Manchester Royal Infirmary and University of Manchester, Manchester, UK

    Rayaz A. Malik MBChB, PhD

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Freeman, R. (2007). Hypoglycemia and the Autonomic Nervous System. In: Veves, A., Malik, R.A. (eds) Diabetic Neuropathy. Clinical Diabetes. Humana Press. https://doi.org/10.1007/978-1-59745-311-0_23

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  • DOI: https://doi.org/10.1007/978-1-59745-311-0_23

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-626-9

  • Online ISBN: 978-1-59745-311-0

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