Counterregulatory hormonal response to insulin-induced hypoglycemia in patients on chronic hemodialysis

Insulin induced hypoglycemia was produced in 5 chronic hemodialysis patients and 5 normal controls. Normally, several counterregulatory hormones (cortisol, growth hormone, glucagon and epinephrine) are secreted. Although we did not measure glucagon in our study, the other hormones were found to respond normally to the hypoglycemia in the control subjects. In the dialysis patients plasma epinephrine response was normal, but no responses of plasma ACTH, cortisol and growth hormone were found. Failure of the other counterregulatory hormones to respond to hypoglycemia indicates that dialysis patients probably maintain their euglycemic state by increasing plasma glucagon and epinephrine concentrations. We were unable to confirm the expected decrease of catecholamines that has been reported during hemodialysis.