Journal article
Blunted glucagon but not epinephrine responses to hypoglycemia occurs in youth with less than 1 yr duration of type 1 diabetes mellitus
Pediatric diabetes, Vol.15(2), pp.127-134
03/2014
DOI: 10.1111/pedi.12070
PMCID: PMC3858506
PMID: 23992543
Abstract
Context
Glycemic control is limited by the barrier of hypoglycemia. Recurrent hypoglycemia impairs counterregulatory (CR) hormone responses to subsequent hypoglycemia.
Objective
To determine the glucagon and epinephrine responses to insulin‐induced hypoglycemia in adolescents with recent‐onset type 1 diabetes mellitus (T1DM).
Methods
We assessed the CR responses to hypoglycemia by performing a hyperinsulinemic (2.0 mU/kg/min), euglycemic (BG 90 mg/dL; 5.0 mmol/L)‐hypoglycemic (BG 55 mg/dL; 3.0 mmol/L) clamp in 25 recent‐onset (<1 yr duration) patients 9–18 yr old (mean ± SD: 13.4 ± 2.7) with T1DM and 16 non‐diabetic controls 19–25 yr old (mean ± SD 23.3 ± 1.8). Twenty of the T1DM subjects were retested 1‐yr (53 ± 3 wk) later.
Results
At the initial and 1‐yr studies, peak glucagon (pGON) and incremental glucagon (ΔGON) during hypoglycemia were lower in the T1DM subjects [median pGON = 47 pg/mL (quartiles: 34, 72), ΔGON = 16 (4, 27) initially and pGON = 50 pg/mL (42, 70), ΔGON = 12 (9, 19) at 1‐yr] than in controls [pGON = 93 pg/mL (60, 111); ΔGON = 38 pg/mL (19, 66), p = 0.01 and p = 0.004 for ΔGON at initial and 1‐yr study, respectively]. In contrast, peak epinephrine (pEPI) and incremental epinephrine (ΔEPI) levels were similar in the T1DM (pEPI = 356 pg/mL (174, 797) and ΔEPI = 322 pg/mL (143, 781) initially and pEPI = 469 pg/mL (305, 595) and ΔEPI = 440 pg/mL (285, 574) at 1 yr) and in controls (pEPI = 383 pg/mL (329, 493) and ΔEPI = 336 pg/mL (298, 471) p = 0.97 and 0.21 for ΔEPI at initial and 1‐yr study, respectively).
Conclusions
Even within the first year of T1DM, glucagon responses to hypoglycemia are blunted but epinephrine responses are not, suggesting that the mechanisms involved in the loss of these hormonal responses, which are key components in pathophysiology of hypoglycemia‐associated autonomic failure, are different.
Details
- Title: Subtitle
- Blunted glucagon but not epinephrine responses to hypoglycemia occurs in youth with less than 1 yr duration of type 1 diabetes mellitus
- Creators
- Ana Maria Arbelaez - St. Louis Children's HospitalDongyuan Xing - Jaeb Center for Health ResearchPhilip E Cryer - Washington University School of MedicineCraig Kollman - Jaeb Center for Health ResearchRoy W Beck - Jaeb Center for Health ResearchJennifer Sherr - Department of Pediatrics, Yale University School of MedicineKatrina J Ruedy - Jaeb Center for Health ResearchWilliam V Tamborlane - Department of Pediatrics, Yale University School of MedicineNelly Mauras - Department of Pediatrics, Nemours Children's ClinicEva Tsalikian - Department of Pediatrics, University of Iowa Children's HospitalDarrell M Wilson - Department of Medicine, Stanford UniversityNeil H White - Washington University School of MedicineDiabetes Research in Children Network (DIRECNET) Study Group
- Resource Type
- Journal article
- Publication Details
- Pediatric diabetes, Vol.15(2), pp.127-134
- Publisher
- John Wiley & Sons A/S
- DOI
- 10.1111/pedi.12070
- PMID
- 23992543
- PMCID
- PMC3858506
- ISSN
- 1399-543X
- eISSN
- 1399-5448
- Number of pages
- 8
- Grant note
- Pediatric Endocrine/Diabetes Physician Scientists (K12 DK094714‐01) Children's Discovery Institute, the National Institutes of Health (UL1RR024992) Harold Amos Medical Faculty Development Program (KL2RR024994) NIH/NICHD (HD41890‐10; HD41906‐10; HD41908‐10; HD41915; HD41918; HD56526; U10 HD05652505; UL1RR024992; UL1RR024139; UL1RR024979; UL1RR025744; UL1RR024150; UL1 RR024150)
- Language
- English
- Date published
- 03/2014
- Academic Unit
- Stead Family Department of Pediatrics; Fraternal Order of Eagles Diabetes Research Center
- Record Identifier
- 9984093217502771
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