During intravenous insulin infusions (40 mU per kilogram of body weight per hour for up to 100 minutes), 9 of 22 patients with insulin-requiring diabetes mellitus had neurologic signs or symptoms of hypoglycemia, plasma glucose concentrations that were below 35 mg per deciliter (1.9 mmol per liter) and continued to decline, or both. This inadequate glucose counterregulation resulted from the combined effect of deficient glucagon and epinephrine responses. In 8 of the 9 patients with inadequate counterregulation severe hypoglycemia developed during subsequent intensive therapy, whereas such episodes occurred in only 1 of 13 patients with adequate counterregulation. Thus, an intravenous insulin-infusion test can prospectively identify patients who are at increased risk for recurrent severe hypoglycemia during intensive therapy for diabetes.
This article has been cited by other articles:
Rossetti, P., Porcellati, F., Busciantella Ricci, N., Candeloro, P., Cioli, P., Nair, K. S., Santeusanio, F., Bolli, G. B., Fanelli, C. G.
(2008). Effect of Oral Amino Acids on Counterregulatory Responses and Cognitive Function During Insulin-Induced Hypoglycemia in Nondiabetic and Type 1 Diabetic People. Diabetes
57: 1905-1917
[Abstract][Full Text]
Arbelaez, A. M., Powers, W. J., Videen, T. O., Price, J. L., Cryer, P. E.
(2008). Attenuation of Counterregulatory Responses to Recurrent Hypoglycemia by Active Thalamic Inhibition: A Mechanism for Hypoglycemia-Associated Autonomic Failure. Diabetes
57: 470-475
[Abstract][Full Text]
Morita, S., Otsuki, M., Izumi, M., Asanuma, N., Izumoto, S., Saitoh, Y., Yoshimine, T., Kasayama, S.
(2007). Reduced epinephrine reserve in response to insulin-induced hypoglycemia in patients with pituitary adenoma. Eur J Endocrinol
157: 265-270
[Abstract][Full Text]
Cheng, H., Zhou, L., Zhu, W., Wang, A., Tang, C., Chan, O., Sherwin, R. S., McCrimmon, R. J.
(2007). Type 1 corticotropin-releasing factor receptors in the ventromedial hypothalamus promote hypoglycemia-induced hormonal counterregulation. Am. J. Physiol. Endocrinol. Metab.
293: E705-E712
[Abstract][Full Text]
Matveyenko, A. V., Bohland, M., Saberi, M., Donovan, C. M.
(2007). Portal vein hypoglycemia is essential for full induction of hypoglycemia-associated autonomic failure with slow-onset hypoglycemia. Am. J. Physiol. Endocrinol. Metab.
293: E857-E864
[Abstract][Full Text]
Cox, D. J., Gonder-Frederick, L., Ritterband, L., Clarke, W., Kovatchev, B. P.
(2007). Prediction of Severe Hypoglycemia. Diabetes Care
30: 1370-1373
[Abstract][Full Text]
McCrimmon, R. J., Fan, X., Cheng, H., McNay, E., Chan, O., Shaw, M., Ding, Y., Zhu, W., Sherwin, R. S.
(2006). Activation of AMP-Activated Protein Kinase Within the Ventromedial Hypothalamus Amplifies Counterregulatory Hormone Responses in Rats With Defective Counterregulation. Diabetes
55: 1755-1760
[Abstract][Full Text]
Matveyenko, A. V., Donovan, C. M.
(2006). Metabolic sensors mediate hypoglycemic detection at the portal vein.. Diabetes
55: 1276-1282
[Abstract][Full Text]
Inouye, K. E., Yue, J. T. Y., Chan, O., Kim, T., Akirav, E. M., Park, E., Riddell, M. C., Burdett, E., Matthews, S. G., Vranic, M.
(2006). Effects of Insulin Treatment without and with Recurrent Hypoglycemia on Hypoglycemic Counterregulation and Adrenal Catecholamine-Synthesizing Enzymes in Diabetic Rats. Endocrinology
147: 1860-1870
[Abstract][Full Text]
Cryer, P. E.
(2005). Mechanisms of Hypoglycemia-Associated Autonomic Failure and Its Component Syndromes in Diabetes. Diabetes
54: 3592-3601
[Abstract][Full Text]
Gosmanov, N. R., Szoke, E., Israelian, Z., Smith, T., Cryer, P. E., Gerich, J. E., Meyer, C.
(2005). Role of the Decrement in Intraislet Insulin for the Glucagon Response to Hypoglycemia in Humans. Diabetes Care
28: 1124-1131
[Abstract][Full Text]
Tomky, D.
(2005). Detection, Prevention, and Treatment of Hypoglycemia in the Hospital. Diabetes Spectr.
18: 39-44
[Abstract][Full Text]
de Galan, B. E., Tack, C. J., Willemsen, J. J., Sweep, C. G. J., Smits, P., Lenders, J. W. M.
(2004). Plasma Metanephrine Levels Are Decreased in Type 1 Diabetic Patients with a Severely Impaired Epinephrine Response to Hypoglycemia, Indicating Reduced Adrenomedullary Stores of Epinephrine. J. Clin. Endocrinol. Metab.
89: 2057-2061
[Abstract][Full Text]
Cryer, P. E., Davis, S. N., Shamoon, H.
(2003). Hypoglycemia in Diabetes. Diabetes Care
26: 1902-1912
[Abstract][Full Text]
Flanagan, D. E., Keshavarz, T., Evans, M. L., Flanagan, S., Fan, X., Jacob, R. J., Sherwin, R. S.
(2003). Role of Corticotrophin-Releasing Hormone in the Impairment of Counterregulatory Responses to Hypoglycemia. Diabetes
52: 605-613
[Abstract][Full Text]
McGregor, V. P., Greiwe, J. S., Banarer, S., Cryer, P. E.
(2002). Limited Impact of Vigorous Exercise on Defenses Against Hypoglycemia: Relevance to Hypoglycemia-Associated Autonomic Failure. Diabetes
51: 1485-1492
[Abstract][Full Text]
Banarer, S., McGregor, V. P., Cryer, P. E.
(2002). Intraislet Hyperinsulinemia Prevents the Glucagon Response to Hypoglycemia Despite an Intact Autonomic Response. Diabetes
51: 958-965
[Abstract][Full Text]
Segel, S. A., Paramore, D. S., Cryer, P. E.
(2002). Hypoglycemia-Associated Autonomic Failure in Advanced Type 2 Diabetes. Diabetes
51: 724-733
[Abstract][Full Text]
Cryer, P. E., Childs, B. P.
(2002). Negotiating the Barrier of Hypoglycemia in Diabetes. Diabetes Spectr.
15: 20-27
[Abstract][Full Text]
Cryer, P. E.
(2001). Hypoglycemia-associated autonomic failure in diabetes. Am. J. Physiol. Endocrinol. Metab.
281: E1115-E1121
[Abstract][Full Text]
Lenhard, M. J., Reeves, G. D.
(2001). Continuous Subcutaneous Insulin Infusion: A Comprehensive Review of Insulin Pump Therapy. Arch Intern Med
161: 2293-2300
[Abstract][Full Text]
Segel, S. A., Fanelli, C. G., Dence, C. S., Markham, J., Videen, T. O., Paramore, D. S., Powers, W. J., Cryer, P. E.
(2001). Blood-to-Brain Glucose Transport, Cerebral Glucose Metabolism, and Cerebral Blood Flow Are Not Increased After Hypoglycemia. Diabetes
50: 1911-1917
[Abstract][Full Text]
Burcelin, R., Thorens, B.
(2001). Evidence That Extrapancreatic GLUT2-Dependent Glucose Sensors Control Glucagon Secretion. Diabetes
50: 1282-1289
[Abstract][Full Text]
Cryer, P. E.
(2000). Editorial: Are Gender Differences in the Responses to Hypoglycemia Relevant to Iatrogenic Hypoglycemia in Type 1 Diabetes?. J. Clin. Endocrinol. Metab.
85: 2145-2147
[Full Text]
Skyler, J. S.
(1989). Intensive Insulin Therapy: A Personal and Historical Perspective. The Diabetes Educator
15: 33-39
Havlin, C. E., Cryer, P. E.
(1988). Hypoglycemia: The Limiting Factor in the Management of Insulin-Dependent Diabetes Mellitus. The Diabetes Educator
14: 407-411
CRYER, P. E
(1986). The sympathochromaffin system and the pituitary-adrenocortical response to hypoglycemia. Science
231: 501-502
Bornemann, M., Holfeldt, F. D.
(1984). Insulin-Induced Hypoglycemia in Type I Diabetics. The Diabetes Educator
10: 13-16
Previous
