Reduced Epinephrine Secretion and Hypoglycemia Unawareness in Diabetic Autonomic Neuropathy

Abstract

The cause of the susceptibility of certain diabetic patients to severe hypoglycemia is not known. Because the awareness of hypoglycemia is heightened by caetecholamine-mediated physiologic responses, deficient catecholamine secretion may cause frequent and severe hypoglycemia. Plasma epinephrine and norepinephrine were measured after insulin-induced hypoglycemia in 18 diabetic patients, 9 with autonomic neuropathy, and in 9 normal volunteers. Two-thirds of patients with diabetic autonomic neuropathy have moderate to severe deficits in epinephrine secretion and these patients have diminished or delayed subjective responses to low blood sugar and are at risk for developing severe hypoglycemia and its neurologic consequences.