Improvement of Impaired Counterregulatory Hormone Response and Symptom Perception by Snort-Term Avoidance of Hypoglycemia in IDDM

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Abstract
OBJECTIVE To test the hypothesis that impaired counterregulatory hormone response and symptom perception, induced by recurrent Hypoglycemic episodes over 2 days, may be improved by short–term (2–day) avoidance of hypoglycemia. RESEARCH DESIGN AND METHODS We examined two groups of insulin-dependent diabetes mellitus (IDDM) patients (n = 16), none of whom exhibited signs of peripheral or autonomie neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed applying stable glycemie plateaus of 5.6, 3.3, 2.2, and 1.7 mmol/l, at which the patients' awareness of and responses to hypoglycemia were evaluated. In the intervention group (n = 11), three short-term Hypoglycemic (n = 5) was introduced to detect adaptation effects caused by the study procedure per se. RESULTS This short-term avoidance of hypoglycemia caused improvement of the impaired counterregulatory hormone response during insulin-induced hypoglycemia involving adrenaline (P < 0.05), adrenocorticotrophic hormone (P < 0.03), and cortisol (P < 0.05). Improvement of hypoglycemia symptom awareness encompassed overall symptom perception (multiple analysis of variance, P < 0.04) and the autonomie symptoms of heart pounding (P < 0.05) and sweating (P < 0.05). CONCLUSIONS The previously reported compromised neuroendocrine coun-terregulation and symptom awareness, occurring as a consequence of repetitive Hypoglycemic episodes over 2 days, may be improved by a single 2-day interval of strict avoidance of hypoglycemia.

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