Curing Diabetes

The body responds to hypoglycemia by producing and releasing counterregulatory hormones, such as glucagon and epinephrine. Usually, this process begins when the glucose level falls below 60 mg/dl.Glucagon, a hormone secreted by the alpha cells of the islets of Langerhans, plays an important role in restoring the blood glucose level to normal. It stimulates the liver to produce glucose through glycogenolysis. The beneficial effect is sustained by gluconeogenesis, in which glucagon forms new glycogen from fatty acids and proteins.

Epinephrine, a catecholamine secreted by the adrenal medulla, increases gluconeogenesis and lipolysis (fat breakdown) by stimulating beta­adrenergic receptors. This process inhibits insulin secretion, causing the blood glucose level to rise, and decreases glucose use by peripheral and visceral tissues.

During prolonged hypoglycemia, other counterregulatory hormones also kick in. Cortisol and growth hormone (GH) help indirectly by reducing insulin’s uptake of glucose at peripheral cell receptor sites.

If glucagon or epinephrine secretion is impaired, recovery from insulin-induced hypoglycemia may be delayed. For example, in Type 1 diabetes, the alpha cells commonly become impaired after 4 to 5 years and no longer secrete glucagon in response to a low blood glucose level. Autonomic neuropathy, a chronic complication of diabetes, and beta-blocker therapy also can impair glucagon secretion. When this happens, epinephrine becomes the primary counterregulatory hormone.

However, if long-standing diabetes impairs or eliminates epinephrine secretion, the patient will develop hypoglycemia unawareness. This condition leaves the patient defenseless against hypoglycemic episodes. She won’t experience the early warning signs, such as tremors and diaphoresis. Eventually, the lack of cerebral glucose will cause her to develop more advanced symptoms, such as confusion and profound lethargy.

The patient’s age and the frequency of hypoglycemic episodes also can affect the body’s compensatory response to hypoglycemia. The amount of epinephrine secreted in response to hypoglycemia diminishes with age. And frequent episodes of hypoglycemia progressively slow the secretion of counterregulatory hormones. Patients who followa regimen of tight glucose control tend to have frequent episodes and are at greater risk for developing profound hypoglycemia.

Filed under: Acute Complication