+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Antecedent hypoglycemia impairs autonomic cardiovascular function: implications for rigorous glycemic control

, : Antecedent hypoglycemia impairs autonomic cardiovascular function: implications for rigorous glycemic control. Diabetes 58(2): 360-366

Glycemic control decreases the incidence and progression of diabetic complications but increases the incidence of hypoglycemia. Hypoglycemia can impair hormonal and autonomic responses to subsequent hypoglycemia. Intensive glycemic control may increase mortality in individuals with type 2 diabetes at high risk for cardiovascular complications. We tested the hypothesis that prior exposure to hypoglycemia leads to impaired cardiovascular autonomic function. Twenty healthy subjects (age 28 +/- 2 years; 10 men) participated in two 3-day inpatient visits, separated by 1-3 months. Autonomic testing was performed on days 1 and 3 to measure sympathetic, parasympathetic, and baroreflex function. A 2-h hyperinsulinemic [hypoglycemic (2.8 mmol/l) or euglycemic (5.0 mmol/l)] clamp was performed in the morning and in the afternoon of day 2. Comparison of the day 3 autonomic measurements demonstrated that antecedent hypoglycemia leads to 1) reduced baroreflex sensitivity (16.7 +/- 1.8 vs. 13.8 +/- 1.4 ms/mmHg, P = 0.03); 2) decreased muscle sympathetic nerve activity response to transient nitroprusside-induced hypotension (53.3 +/- 3.7 vs. 40.1 +/- 2.7 bursts/min, P < 0.01); and 3) reduced (P < 0.001) plasma norepinephrine response to lower body negative pressure (3.0 +/- 0.3 vs. 2.0 +/- 0.2 nmol/l at -40 mmHg). Baroreflex sensitivity and the sympathetic response to hypotensive stress are attenuated after antecedent hypoglycemia. Because impaired autonomic function, including decreased cardiac vagal baroreflex sensitivity, may contribute directly to mortality in diabetes and cardiovascular disease, our findings raise new concerns regarding the consequences of hypoglycemia.


PMID: 19056608

DOI: 10.2337/db08-1153

Other references

Schulte, B.; Grunert, E.; Andresen, P., 1980: Oestrus synchronization in heifers with the prostaglandin analog Reprodin. In 37 heifers injected i/m with 2 ml Reprodin (15 mg) twice at 11 days interval conception rate after the first insemination was 40.5% compared with 35.1% in controls. In the 2 groups 5 and 7 conceived after the second insemination, 4 and 5 after...

Holdsworth, B.J.; Mossad, M.M., 1990: Fractures of the adult distal humerus. Elbow function after internal fixation. We reviewed 57 adult patients at an average of 37 months after early internal fixation for displaced fractures of the distal humerus. Two-thirds had intercondylar (Müller type C) fractures, and one-third had articular comminution (type C3). A che...

Ganne Carrie, Nathalie, 2004: A gene-expression profile of hepatocellular carcinoma predictive of early intrahepatic recurrence after curative resection. Gastroenterologie Clinique et Biologique 28(1): 102-103, Janvier

Reperant, L.A.; Kuiken, T.; Grenfell, B.T.; Osterhaus, A.D.M.E.; Dobson, A.P., 2013: Linking influenza virus tissue tropism to population-level reproductive fitness. Influenza virus tissue tropism defines the host cells and tissues that support viral replication and contributes to determining which regions of the respiratory tract are infected in humans. The location of influenza virus infection along the resp...

Halpern, A.C.; Guerry, D.; Elder, D.E.; Trock, B.; Synnestvedt, M., 1993: A cohort study of melanoma in patients with dysplastic nevi. A historical cohort of 153 patients with dysplastic nevi was studied for the development of melanoma. Each subject had a minimum follow-up of 5 years, with an average study follow-up of 94 months. Eleven new melanomas developed in 11 patients betw...

Pietsch-Breitfeld, B.; Heizmann, G.; Selbmann, H-K., 2002: Not Available. Within the demonstration project "Quality Management in Hospitals" (DemoProQM), 44 hospitals, organised in ten collaborative project groups, were supported by the German Ministry of Health from 1998 to 2001 in their methods for implement...

Massie, J.; Ali, J.M., 2015: Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings. Workplace based assessments (WBAs) are now commonplace in postgraduate medical training. User acceptability and engagement is essential to the success of any medical education innovation. To this end, possessing an insight into trainee and trainer...

Hayano, M.; Tsuruta, M.; Mori, H.; Takayanagi, K.; Inoue, J.; Matsuo, S., 1983: Case of type-A Wolff-Parkinson-White (WPW) syndrome with dual atrioventricular nodal pathways. Nihon Naika Gakkai Zasshi. Journal of the Japanese Society of Internal Medicine 72(12): 1756-1761

Van Heyningen, R., 1971: Fluorescent derivatives of 3-hydroxy-L-kynurenine in the lens of man, the baboon and the grey squirrel. Biochemical Journal 123(4): 30p-31p

Jayaweera, A.R.; Sklenar, J.; Kaul, S., 1994: Quantification of images obtained during myocardial contrast echocardiography. This article describes currently used quantitative methods for analysis of data obtained during myocardial contrast echocardiography. The specific issues addressed are: obtaining time-intensity curves from the myocardium in order to derive transit...