Plasma Glucose Concentrations at the Onset of Hypoglycemic Symptoms in Patients with Poorly Controlled Diabetes and in Nondiabetics
We tested the hypothesis that during decrements in plasma glucose concentration, symptoms of hypoglycemia may occur at higher glucose concentrations in patients with poorly controlled insulin-dependent diabetes mellitus than in persons without diabetes. Symptoms of hypoglycemia and counterregulatory...
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| Veröffentlicht in: | The New England journal of medicine 1988-06, Vol.318 (23), p.1487-1492 |
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| creator | Boyle, Patrick J Schwartz, Natalie S Shah, Suresh D Clutter, William E Cryer, Philip E |
| description | We tested the hypothesis that during decrements in plasma glucose concentration, symptoms of hypoglycemia may occur at higher glucose concentrations in patients with poorly controlled insulin-dependent diabetes mellitus than in persons without diabetes. Symptoms of hypoglycemia and counterregulatory neuroendocrine responses were quantified during hypoglycemic and euglycemic clamp studies in eight patients with insulin-dependent diabetes mellitus selected because their hemoglobin A
1
levels were above 10 percent. These data were compared with similar observations in 10 nondiabetic subjects studied previously.
Glycemic thresholds — the plasma glucose concentrations during each hypoglycemic clamp study at which a given symptom or biochemical measurement first exceeded its 95 percent confidence interval determined in the euglycemic clamp studies — were calculated for each variable. The mean (±SE) glycemic threshold for the symptoms of hypoglycemia was 4.3±0.3 mmol per liter (78±5 mg per deciliter) in patients with poorly controlled diabetes — significantly higher (P |
| doi_str_mv | 10.1056/NEJM198806093182302 |
| format | Article |
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1
levels were above 10 percent. These data were compared with similar observations in 10 nondiabetic subjects studied previously.
Glycemic thresholds — the plasma glucose concentrations during each hypoglycemic clamp study at which a given symptom or biochemical measurement first exceeded its 95 percent confidence interval determined in the euglycemic clamp studies — were calculated for each variable. The mean (±SE) glycemic threshold for the symptoms of hypoglycemia was 4.3±0.3 mmol per liter (78±5 mg per deciliter) in patients with poorly controlled diabetes — significantly higher (P<0.001) than the value of 2.9±0.1 mmol per liter (53±2 mg per deciliter) in subjects without diabetes. The mean glycemic thresholds for growth hormone, epinephrine, and cortisol secretions were not significantly different in the two groups.
Thus, during decreases in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher plasma glucose concentrations than persons without diabetes. The mechanism underlying this observation remains to be defined. (N Engl J Med 1988; 318:1487–92.)
FOR decades the clinical impression has been widespread that during decrements in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher glucose concentrations than persons without diabetes.
1
In contrast, patients with intensively treated insulin-dependent diabetes mellitus appear to tolerate subnormal plasma glucose concentrations without symptoms.
2
,
3
After several months of intensive therapy that effectively lowered their overall plasma glucose concentrations, patients with insulin-dependent diabetes mellitus had blunted glucose-counterregulatory hormone responses to a fixed hypoglycemic stimulus
2
and lower plateau levels of plasma glucose during low-dose insulin infusions.
3
During insulin infusions, the symptoms of . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJM198806093182302</identifier><identifier>PMID: 3285214</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Boston, MA: Massachusetts Medical Society</publisher><subject>Adult ; Associated diseases and complications ; Biological and medical sciences ; Blood Glucose - analysis ; Cortisol ; Diabetes mellitus ; Diabetes Mellitus, Type 1 - blood ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Epinephrine ; Epinephrine - blood ; Female ; Glucagon - blood ; Glucose ; Growth Hormone - blood ; Growth hormones ; Hemoglobin ; Humans ; Hydrocortisone - blood ; Hypoglycemia ; Hypoglycemia - blood ; Hypoglycemia - physiopathology ; Insulin ; Insulin - blood ; Male ; Medical sciences ; Neuroendocrine system ; Norepinephrine - blood ; Secretions</subject><ispartof>The New England journal of medicine, 1988-06, Vol.318 (23), p.1487-1492</ispartof><rights>1989 INIST-CNRS</rights><rights>Copyright Massachusetts Medical Society Jun 9, 1988</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-5cc6959062c504a721cc9ef67cb8c005c4b474aec72aca321e9ba8f2adb513d63</citedby><cites>FETCH-LOGICAL-c432t-5cc6959062c504a721cc9ef67cb8c005c4b474aec72aca321e9ba8f2adb513d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1881504467?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7293631$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3285214$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boyle, Patrick J</creatorcontrib><creatorcontrib>Schwartz, Natalie S</creatorcontrib><creatorcontrib>Shah, Suresh D</creatorcontrib><creatorcontrib>Clutter, William E</creatorcontrib><creatorcontrib>Cryer, Philip E</creatorcontrib><title>Plasma Glucose Concentrations at the Onset of Hypoglycemic Symptoms in Patients with Poorly Controlled Diabetes and in Nondiabetics</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>We tested the hypothesis that during decrements in plasma glucose concentration, symptoms of hypoglycemia may occur at higher glucose concentrations in patients with poorly controlled insulin-dependent diabetes mellitus than in persons without diabetes. Symptoms of hypoglycemia and counterregulatory neuroendocrine responses were quantified during hypoglycemic and euglycemic clamp studies in eight patients with insulin-dependent diabetes mellitus selected because their hemoglobin A
1
levels were above 10 percent. These data were compared with similar observations in 10 nondiabetic subjects studied previously.
Glycemic thresholds — the plasma glucose concentrations during each hypoglycemic clamp study at which a given symptom or biochemical measurement first exceeded its 95 percent confidence interval determined in the euglycemic clamp studies — were calculated for each variable. The mean (±SE) glycemic threshold for the symptoms of hypoglycemia was 4.3±0.3 mmol per liter (78±5 mg per deciliter) in patients with poorly controlled diabetes — significantly higher (P<0.001) than the value of 2.9±0.1 mmol per liter (53±2 mg per deciliter) in subjects without diabetes. The mean glycemic thresholds for growth hormone, epinephrine, and cortisol secretions were not significantly different in the two groups.
Thus, during decreases in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher plasma glucose concentrations than persons without diabetes. The mechanism underlying this observation remains to be defined. (N Engl J Med 1988; 318:1487–92.)
FOR decades the clinical impression has been widespread that during decrements in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher glucose concentrations than persons without diabetes.
1
In contrast, patients with intensively treated insulin-dependent diabetes mellitus appear to tolerate subnormal plasma glucose concentrations without symptoms.
2
,
3
After several months of intensive therapy that effectively lowered their overall plasma glucose concentrations, patients with insulin-dependent diabetes mellitus had blunted glucose-counterregulatory hormone responses to a fixed hypoglycemic stimulus
2
and lower plateau levels of plasma glucose during low-dose insulin infusions.
3
During insulin infusions, the symptoms of . . .</description><subject>Adult</subject><subject>Associated diseases and complications</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose - analysis</subject><subject>Cortisol</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 1 - blood</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Epinephrine</subject><subject>Epinephrine - blood</subject><subject>Female</subject><subject>Glucagon - blood</subject><subject>Glucose</subject><subject>Growth Hormone - blood</subject><subject>Growth hormones</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - blood</subject><subject>Hypoglycemia - physiopathology</subject><subject>Insulin</subject><subject>Insulin - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neuroendocrine system</subject><subject>Norepinephrine - blood</subject><subject>Secretions</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1988</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU1rFEEQhhtR4ib6C0RoUHKR0f6ame6jrDFRYrKgnoeemh4zS39sunuQOfvH7XWXHESsS0HV875V8CL0gpK3lNTNu5uLz1-okpI0RHEqGSfsEVrRmvNKCNI8RitCmKxEq_hTdJrSlpSiQp2gE85kzahYoV8bq5PT-NLOEJLB6-DB-Bx1noJPWGec7wy-9clkHEZ8tezCD7uAcRPgr4vb5eASnjzeFEHRJfxzynd4E0K0y94sx2CtGfCHSfcmm-Lohz1_E_zwZzRBeoaejNom8_zYz9D3jxff1lfV9e3lp_X76woEZ7mqARpVK9IwqInQLaMAyoxNC70EQmoQvWiFNtAyDZozalSv5cj00NeUDw0_Q-cH310M97NJuXNTAmOt9ibMqWslI60SpICv_gK3YY6-_NZRKWm5Lpq2UPxAQQwpRTN2uzg5HZeOkm4fUPePgIrq5dF77p0ZHjTHRMr-9XGvE2g7Ru1hSg9YyxRvOC3YmwPmXOq82br_Hv0NNQiloA</recordid><startdate>19880609</startdate><enddate>19880609</enddate><creator>Boyle, Patrick J</creator><creator>Schwartz, Natalie S</creator><creator>Shah, Suresh D</creator><creator>Clutter, William E</creator><creator>Cryer, Philip E</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>19880609</creationdate><title>Plasma Glucose Concentrations at the Onset of Hypoglycemic Symptoms in Patients with Poorly Controlled Diabetes and in Nondiabetics</title><author>Boyle, Patrick J ; Schwartz, Natalie S ; Shah, Suresh D ; Clutter, William E ; Cryer, Philip E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-5cc6959062c504a721cc9ef67cb8c005c4b474aec72aca321e9ba8f2adb513d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1988</creationdate><topic>Adult</topic><topic>Associated diseases and complications</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose - analysis</topic><topic>Cortisol</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus, Type 1 - blood</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Epinephrine</topic><topic>Epinephrine - blood</topic><topic>Female</topic><topic>Glucagon - blood</topic><topic>Glucose</topic><topic>Growth Hormone - blood</topic><topic>Growth hormones</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - blood</topic><topic>Hypoglycemia - physiopathology</topic><topic>Insulin</topic><topic>Insulin - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Neuroendocrine system</topic><topic>Norepinephrine - blood</topic><topic>Secretions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boyle, Patrick J</creatorcontrib><creatorcontrib>Schwartz, Natalie S</creatorcontrib><creatorcontrib>Shah, Suresh D</creatorcontrib><creatorcontrib>Clutter, William E</creatorcontrib><creatorcontrib>Cryer, Philip E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>New England Journal of Medicine</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boyle, Patrick J</au><au>Schwartz, Natalie S</au><au>Shah, Suresh D</au><au>Clutter, William E</au><au>Cryer, Philip E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma Glucose Concentrations at the Onset of Hypoglycemic Symptoms in Patients with Poorly Controlled Diabetes and in Nondiabetics</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>1988-06-09</date><risdate>1988</risdate><volume>318</volume><issue>23</issue><spage>1487</spage><epage>1492</epage><pages>1487-1492</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>We tested the hypothesis that during decrements in plasma glucose concentration, symptoms of hypoglycemia may occur at higher glucose concentrations in patients with poorly controlled insulin-dependent diabetes mellitus than in persons without diabetes. Symptoms of hypoglycemia and counterregulatory neuroendocrine responses were quantified during hypoglycemic and euglycemic clamp studies in eight patients with insulin-dependent diabetes mellitus selected because their hemoglobin A
1
levels were above 10 percent. These data were compared with similar observations in 10 nondiabetic subjects studied previously.
Glycemic thresholds — the plasma glucose concentrations during each hypoglycemic clamp study at which a given symptom or biochemical measurement first exceeded its 95 percent confidence interval determined in the euglycemic clamp studies — were calculated for each variable. The mean (±SE) glycemic threshold for the symptoms of hypoglycemia was 4.3±0.3 mmol per liter (78±5 mg per deciliter) in patients with poorly controlled diabetes — significantly higher (P<0.001) than the value of 2.9±0.1 mmol per liter (53±2 mg per deciliter) in subjects without diabetes. The mean glycemic thresholds for growth hormone, epinephrine, and cortisol secretions were not significantly different in the two groups.
Thus, during decreases in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher plasma glucose concentrations than persons without diabetes. The mechanism underlying this observation remains to be defined. (N Engl J Med 1988; 318:1487–92.)
FOR decades the clinical impression has been widespread that during decrements in the plasma glucose concentration, patients with poorly controlled insulin-dependent diabetes mellitus may experience symptoms of hypoglycemia at higher glucose concentrations than persons without diabetes.
1
In contrast, patients with intensively treated insulin-dependent diabetes mellitus appear to tolerate subnormal plasma glucose concentrations without symptoms.
2
,
3
After several months of intensive therapy that effectively lowered their overall plasma glucose concentrations, patients with insulin-dependent diabetes mellitus had blunted glucose-counterregulatory hormone responses to a fixed hypoglycemic stimulus
2
and lower plateau levels of plasma glucose during low-dose insulin infusions.
3
During insulin infusions, the symptoms of . . .</abstract><cop>Boston, MA</cop><pub>Massachusetts Medical Society</pub><pmid>3285214</pmid><doi>10.1056/NEJM198806093182302</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0028-4793 |
| ispartof | The New England journal of medicine, 1988-06, Vol.318 (23), p.1487-1492 |
| issn | 0028-4793 1533-4406 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_78207940 |
| source | MEDLINE; ProQuest Central UK/Ireland |
| subjects | Adult Associated diseases and complications Biological and medical sciences Blood Glucose - analysis Cortisol Diabetes mellitus Diabetes Mellitus, Type 1 - blood Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Epinephrine Epinephrine - blood Female Glucagon - blood Glucose Growth Hormone - blood Growth hormones Hemoglobin Humans Hydrocortisone - blood Hypoglycemia Hypoglycemia - blood Hypoglycemia - physiopathology Insulin Insulin - blood Male Medical sciences Neuroendocrine system Norepinephrine - blood Secretions |
| title | Plasma Glucose Concentrations at the Onset of Hypoglycemic Symptoms in Patients with Poorly Controlled Diabetes and in Nondiabetics |
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