SUMMARY

Widespread implementation of regimens to rigorously control blood sugar in patients with diabetes has led to an increased incidence of severe iatrogenic hypoglycemic events with substantial morbidity and mortality. Hypoglycemia provokes a sequence of counterregulatory metabolic, neural, and clinical responses. Insulin secretion decreases whereas glucagon, epinephrine, norepinephrine, pancreatic polypeptide, cortisol, and growth hormone increase. The sympathetic, parasympathetic, and sympatho-adrenal divisions of the autonomic nervous system are activated in response to the falling blood sugar. The spectrum of reduced counterreg-ulatory hormone responses (in particular epinephrine) and decreased symptom perception of hypoglycemia because of decreased autonomic nervous system activation following recent antecedent hypoglycemia has been termed "hypoglycemia induced autonomic failure." This leads to a vicious cycle of hypoglycemia unawareness that induces a further decrease in coun-terregulatory hormone responses to hypoglycemia. This vicious cycle occurs commonly in diabetic subjects in strict glycemic control. The reduced epinephrine response to antecedent hypoglycemia occurs in the absence of diabetic autonomic neuropathy as measured by standard tests of autonomic function. The presence of autonomic neuropathy, however, further attenuates the epinephrine response to hypoglycemia in diabetic subjects after recent hypoglycemic exposure. The mechanisms of hypoglycemia induced autonomic failure are not fully elucidated.

Key Words: Autonomic failure; autonomic neuropathy; counterregulation; hypoglycemia; hypothalamus sympathetic nervous system.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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