Evidence that hyperglycemia after recovery from hypoglycemia worsens endothelial function and increases oxidative stress and inflammation in healthy control subjects and subjects with type 1 diabetes.
Currently there is debate on whether hypoglycemia is an independent risk factor for atherosclerosis, but little attention has been paid to the effects of recovery from hypoglycemia. In normal control individuals and in people with type 1 diabetes, recovery from a 2-h induced hypoglycemia was obtained by reaching normoglycemia or hyperglycemia for another 2 h and then maintaining normal glycemia for the following 6 h. Hyperglycemia after hypoglycemia was also repeated with the concomitant infusion of vitamin C. Recovery with normoglycemia is accompanied by a significant improvement in endothelial dysfunction, oxidative stress, and inflammation, which are affected by hypoglycemia; however, a period of hyperglycemia after hypoglycemia worsens all of these parameters, an effect that persists even after the additional 6 h of normoglycemia. This effect is partially counterbalanced when hyperglycemia after hypoglycemia is accompanied by the simultaneous infusion of vitamin C, suggesting that when hyperglycemia follows hypoglycemia, an ischemia-reperfusion-like effect is produced. This study shows that the way in which recovery from hypoglycemia takes place in people with type 1 diabetes could play an important role in favoring the appearance of endothelial dysfunction, oxidative stress, and inflammation, widely recognized cardiovascular risk factors.
Department of Endocrinology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. aceriell@clinic.ub.es
Antonio
A
Ceriello
Anna
A
Novials
Emilio
E
Ortega
Lucia
L
La Sala
Gemma
G
Pujadas
Roberto
R
Testa
Anna Rita
AR
Bonfigli
Katherine
K
Esposito
Dario
D
Giugliano
D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000276:immunology / Q000503:physiopathology*; D007003:Hypoglycemia / Q000139:chemically induced / Q000276:immunology / Q000503:physiopathology* / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D018836:Inflammation Mediators / Q000097:blood; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D018384:Oxidative Stress / Q000187:drug effects*; D012307:Risk Factors; D014664:Vasodilation / Q000187:drug effects; D055815:Young Adult
D000975:Antioxidants; D007004:Hypoglycemic Agents; D018836:Inflammation Mediators; D007328:Insulin; D005947:Glucose; D001205:Ascorbic Acid