title: Exaggerated epinephrine response to hypoglycemia in a physically fit, well-controlled IDDM subject.
abstract: Metabolically well controlled insulin-dependent diabetic subjects (IDDM) have deficient autonomic adrenomedullary responses to hypoglycemia. This defect, coupled with the characteristic deficient glucagon response to hypoglycemia, predisposes well-controlled IDDM subjects to an increased incidence of severe hypoglycemic episodes. In this report we describe a physically trained subject with long-duration IDDM (9 years) who was rigorously well-controlled (normal HBA1c), yet had exaggerated epinephrine responses to hypoglycemia compared with normal controls. Steady state epinephrine levels during a low-dose insulin (9 pM/kg/min) hypoglycemic clamp (2.9 +/- 0.1 mM) were approximately 2-fold higher compared with normal controls (10.6 vs. 5.5 +/- 0.7 nM). Epinephrine levels during a high-dose insulin (30 pM/kg/min) hypoglycemic clamp (2.8 +/- 0.1 mM) were also increased compared with normal controls (13.1 vs. 8.8 +/- 0.6 nM). We conclude that physical training in this metabolically well-controlled IDDM subject was associated with an augmented autonomic adrenomedullary response to hypoglycemia.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2230.
authors.forename: S N
authors.initials: SN
authors.lastname: Davis
authors.forename: R E
authors.initials: RE
authors.lastname: Goldstein
authors.forename: A D
authors.initials: AD
authors.lastname: Cherrington
authors.forename: L
authors.initials: L
authors.lastname: Price
mesh_terms: D020155:3-Hydroxybutyric Acid; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology*; D004837:Epinephrine / Q000097:blood* / Q000378:metabolism; D015444:Exercise; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005934:Glucagon / Q000097:blood; D013006:Growth Hormone / Q000097:blood; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006885:Hydroxybutyrates / Q000097:blood; D007003:Hypoglycemia / Q000097:blood / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D008099:Liver / Q000378:metabolism; D008297:Male; D010191:Pancreatic Polypeptide / Q000097:blood; D010809:Physical Fitness; D012016:Reference Values; D013177:Sports
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D007328:Insulin; D007773:Lactates; D010191:Pancreatic Polypeptide; D013006:Growth Hormone; D005934:Glucagon; D020155:3-Hydroxybutyric Acid; D006854:Hydrocortisone; D004837:Epinephrine