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Changes in platelet function, blood coagulation and fibrinolysis during insulin-induced hypoglycaemia in juvenile
Insights
Insulin-induced hypoglycemia affects blood clotting differently in juvenile diabetics compared to non-diabetics. Diabetics show altered platelet aggregation, reduced platelet counts, and prolonged clot lysis times post-hypoglycemia.
Area of Science:
- Endocrinology
- Hematology
- Metabolic Disorders
Background:
- Insulin-induced hypoglycemia can impact various physiological systems.
- Understanding its effects on hemostasis is crucial, especially in diabetic patients.
Purpose of the Study:
- To investigate the effects of insulin-induced hypoglycemia on hemostatic parameters in juvenile diabetics versus non-diabetic controls.
- To compare platelet function, coagulation times, and fibrinolysis between the two groups.
Main Methods:
- Assessed hemostatic parameters (platelet aggregation, count, APTT, fibrinogen, Factor VIII R:Ag, ELT) before and after insulin infusion in 7 non-diabetics and 8 juvenile diabetics.
- Induced platelet aggregation in vitro using adenosine diphosphate (ADP).
Main Results:
- Diabetics exhibited lower platelet aggregation at lower ADP concentrations and significantly reduced platelet counts post-hypoglycemia.
- Activated partial thromboplastin time (APTT) was reduced in both groups, but significantly lower in diabetics 120 min after insulin infusion.
- Fibrinogen and Factor VIII R:Ag increased post-insulin infusion, with higher values in diabetics. Euglobulin clot lysis time (ELT) was prolonged in diabetics 120 min after insulin infusion.
Conclusions:
- Insulin-induced hypoglycemia significantly alters hemostatic parameters in juvenile diabetics, suggesting a prothrombotic tendency.
- These findings highlight potential hemostatic dysregulation in diabetic patients experiencing hypoglycemia.
Abstract:
Haemostatic parameters were assessed before insulin induced hypoglycaemia and 0, 1 and 2 hr after discontinuation of insulin infusion in 7 non-diabetics, aged 28 (22-31) years (mean and range), and 8 juvenile diabetics, aged 31 (27-35) years, with a mean duration of diabetes of 4 years. The patients were normoglycaemic for at least 10 hr before the study. Platelet aggregation in vitro was induced by lower adenosine diphosphate (ADP) concentrations in the diabetics than in the controls before hypoglycaemia and 0 and 60 min after insulin infusion. Platelet counts decreased significantly in the diabetics after hypoglycaemia, whereas no changes were seen in the control group. The activated partial thromboplastin time (APTT) was reduced in both groups and significantly lower in the diabetics than in the controls 120 min after insulin infusion. Fibrinogen and factor VIII R:Ag increased after insulin infusion; highest values were seen in the diabetics. The euglobulin clot lysis time (ELT) was reduced in both groups during insulin infusion; 120 min after end of insulin infusion ELT was significantly longer in the diabetics than in the control group.