Failure of Warning in Insulin-induced Hypoglycemic Reactions

Abstract

Response to insulin-induced hypoglycemia was studied in 44 patients with diabetes mellitus and five nondiabetic subjects. The progressive physiological changes observed in hypoglycemia were as follows: parasympathetic response, phase of diminished cerebral function, sympathetic response and hypoglycemic coma. On the basis of clinical manifestations and the measurement of plasma FFA and plasma catecholamines, the diabetic patients could be classified into three groups. Class I comprised those patients who had subjective warning of a hypoglycemic reaction and evidence of sympathetic nervous system hyperactivity. Class II included those patients with no awareness of a reaction but in whom a sympathetic response was present. In Class III were patients who had no warning and in whom sympathetic nervous system changes were absent. Glucagon ( 1 mg.) administered intravenously produced a rise in the venous blood glucose and an improvement of the clinical status in 11 diabetic patients who were in hypoglycemic coma.