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[IPp] Diabetics Show Muted Response To Hypoglycemia During Sleep

Diabetics Show Muted Response to Hypoglycemia During Sleep
 The autonomic response to hypoglycemia is reduced during sleep in patients with
type 1 diabetes, researchers report in the May issue of Diabetes.

 Senior investigator Dr. Philip E. Cryer stated that, "treatment-induced
hypoglycemia, particularly night-time hypoglycemia, is a problem for people with
diabetes that has not been solved."

 To test the hypothesis that sleep further compromises already defective
defenses against hypoglycemia, Dr. Cryer and Dr. Salomon Banarer of Washington
University, St. Louis, Missouri, studied 8 patients with uncomplicated type 1
diabetes and 8 matched controls.
 Responses to induced hypoglycemia were altered in the diabetics while they
slept compared with when they were awake. In particular, mean plasma levels of
epinephrine during hypoglycemia fell from 240 pg/mL while awake to 85 pg/mL
while asleep. For plasma norepinephrine, these values were 205 and 148 pg/mL and
for pancreatic polypeptide, 197 and 118 pg/mL. Such attenuated responses during
sleep were not seen in the control subjects.

 Furthermore, during certain hypoglycemic episodes, diabetics spent 77% of their
time asleep. The corresponding proportion for controls was only 26%.

 The researchers thus conclude that autonomic responses to hypoglycemia are
diminished during sleep and "probably" because of their reduced sympathoadrenal
responses, such patients "are substantially less likely to be awakened by

 "Ultimately," Dr. Cryer continued, "people with diabetes need plasma
glucose-regulated insulin secretion or replacement if we are to safely achieve
true glucose control--with its well-established long-term benefits."

 "In the meantime," he added, "we need to learn to prevent, correct or
compensate for compromised defenses against falling plasma glucose
concentrations." Diabetes 2003; 52:1195-1203.

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