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Effect of short-term glucose control on glycemic thresholds for epinephrine and hypoglycemic symptoms

M R Burge1, T A Sobhy, C R Qualls

  • 1Department of Medicine/Endocrinology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA. MBurge@Salud.unm.edu

The Journal of Clinical Endocrinology and Metabolism
|November 10, 2001
PubMed

Insights

Intensive diabetes management in elderly type 2 diabetes patients rapidly lowered blood glucose but increased hypoglycemia symptom and hormone response thresholds. This may raise severe hypoglycemia risks and limit hyperglycemia treatment.

Area of Science:

  • Endocrinology
  • Metabolism
  • Geriatrics

Background:

  • Hypoglycemia is a major obstacle in managing type 2 diabetes.
  • The impact of short-term glycemic control improvements on hypoglycemia response thresholds in type 2 diabetes is not well understood.

Purpose of the Study:

  • To investigate if one week of improved glycemic control increases plasma glucose thresholds for symptomatic and hormonal responses to hypoglycemia in elderly patients with type 2 diabetes.

Main Methods:

  • Ten elderly type 2 diabetes patients underwent insulin-induced hypoglycemia before and after an 8-day intensive diabetes management protocol.
  • Plasma glucose, counterregulatory hormones, and symptoms were measured during hypoglycemia.
  • Blood glucose profiles were monitored daily.

Main Results:

  • Intensive management significantly reduced mean blood glucose from 9.8 to 7.7 mmol/L.
  • The plasma glucose threshold for epinephrine release increased significantly after intensive management (3.7 to 3.1 mmol/L).
  • The plasma glucose threshold for hypoglycemic symptoms also significantly increased (5.3 to 3.3 mmol/L).

Conclusions:

  • Rapid improvement in glycemic control in elderly type 2 diabetes patients can increase hypoglycemia symptom and hormonal response thresholds.
  • These changes may elevate the risk of severe hypoglycemia and complicate rapid hyperglycemia correction.

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