Duration of type I diabetes affects glucagon and glucose responses to insulin-induced hypoglycemia
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Abstract:
The glucagon response to hypoglycemia, which fulfills a primary role toward restoring the plasma glucose level, is blunted or absent in most patients with type I diabetes. To identify predictive factors for this abnormality and for the capability of glycemic counterregulation, we investigated the relationship between the duration of diabetes and glucagon and glucose responses to insulin-induced hypoglycemia. In 18 type I diabetic patients with 1 through 28 years of disease who had no detectable autonomic neuropathy, individual glucagon increments after insulin hypoglycemia were inversely correlated with the duration of disease (r = -.53, P < .025). Patients with disease for ten or fewer years showed a glucagon rise that was lower than in controls but significantly higher than in patients with a duration of more than ten years. The plasma glucose rise after the nadir correlated with peak glucagon increments (r = .60, P < .01); eight of the nine patients with glycemic increments comparable to normals had had diabetes for ten years or less. Thus, having diabetes for more than ten years implied that not only were glucagon responses to insulin hypoglycemia severely compromised but also that the abrupt restoration of plasma glucose levels was impaired. These findings should be taken into account when establishing goals and modalities for tight metabolic control.
Insights
In type 1 diabetes, longer disease duration impairs the glucagon response to hypoglycemia, hindering glucose restoration. This affects glycemic counterregulation, especially after ten years of diabetes.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Research
Background:
- Glucagon is crucial for restoring plasma glucose levels during hypoglycemia.
- This glucagon response is often blunted or absent in type 1 diabetes patients.
- Glycemic counterregulation capability is vital for managing diabetes.
Purpose of the Study:
- To identify factors predicting impaired glucagon response to hypoglycemia in type 1 diabetes.
- To investigate the relationship between diabetes duration and glycemic counterregulation.
- To understand the impact of disease duration on hormonal responses to hypoglycemia.
Main Methods:
- Studied 18 type 1 diabetes patients (1-28 years duration) without autonomic neuropathy.
- Administered insulin-induced hypoglycemia to assess glucagon and glucose responses.
- Correlated disease duration with glucagon increments and plasma glucose recovery.
Main Results:
- Glucagon increments post-hypoglycemia inversely correlated with diabetes duration (r=-.53, P<.025).
- Patients with diabetes >10 years showed severely compromised glucagon responses compared to shorter durations.
- Plasma glucose recovery correlated with peak glucagon (r=.60, P<.01); shorter durations (<10 years) showed better recovery.
Conclusions:
- Diabetes duration exceeding ten years significantly impairs glucagon response to hypoglycemia.
- Longer diabetes duration compromises the ability to restore plasma glucose levels.
- Findings impact strategies for tight metabolic control in type 1 diabetes.