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Contrarregulación de la hipoglucemia a concentraciones normales de glucosa en sangre en pacientes con diabetes tipo 2
G Spyer1, A T Hattersley, I A MacDonald
1Department of Vascular Medicine and Diabetes Research, School of Postgraduate Medicine and Health Sciences, Exeter, Devon, UK.
Lancet (London, England)
|December 29, 2000
Resumen
Los pacientes con diabetes tipo 2 bien controlados experimentan síntomas y liberación de hormonas a niveles más altos de glucosa en sangre. Esta respuesta alterada puede proteger contra la hipoglucemia grave, pero complica el logro de un control normal del azúcar en la sangre.
Área de la Ciencia:
- Endocrinología Endocrinología.
- Trastornos metabólicos Los trastornos metabólicos son trastornos metabólicos que se producen en el cuerpo.
- Investigación de la diabetes Investigación de la diabetes.
Sus antecedentes:
- El control glucémico intensivo en la diabetes a menudo está limitado por la hipoglucemia.
- Los niveles específicos de glucosa que desencadenan los síntomas y la liberación de hormonas contrarreguladoras en la diabetes tipo 2 bien controlada no se comprenden bien.
Objetivo del estudio:
- Investigar las concentraciones de glucosa a las que se producen los síntomas y la liberación de hormonas contra-reguladoras en pacientes diabéticos tipo 2 no tratados con insulina, bien controlados, en comparación con controles sanos.
Principales métodos:
- Se realizó una pinza de glucosa hipoglucémica hiperinsulinémica escalonada en siete pacientes con diabetes tipo 2 y siete controles sanos.
- Las mediciones incluyeron la percepción de los síntomas, la función cognitiva y los niveles de hormonas contrarreguladoras (epinefrina, norepinefrina, hormona del crecimiento, cortisol) en cada meseta de glucosa.
Principales resultados:
- Los pacientes diabéticos informaron síntomas en concentraciones significativamente más altas de glucosa en sangre que los controles.
- La liberación de hormonas contrarreguladoras, incluida la epinefrina, también se produjo a niveles más altos de glucosa en pacientes diabéticos (por ejemplo, 3,8 mmol / L frente a 2,6 mmol / L).
Conclusiones:
- Los umbrales de glucosa alterados para la secreción de hormonas contrarreguladoras y la percepción de los síntomas existen en la diabetes tipo 2 bien controlada.
- Estas adaptaciones pueden ofrecer protección contra la hipoglucemia profunda, pero presentan desafíos para lograr la normoglucemia en la práctica clínica.
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