[ Back to EurekAlert! ] Public release date: 26-Feb-2007
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Public Library of Science

Patients with type 1 diabetes don't wake in response to hypoglycemia

A study of 16 patients with type 1 diabetes mellitus (T1DM) and 16 normal individuals shows that only one of the 16 T1DM patients, as compared to ten healthy control participants, awakened upon hypoglycemia.

Bernd Schultes and colleagues from the University of Lubeck induced hypoglycemia with insulin under controlled conditions and then assessed sleep with polysomography. A fall in plasma glucose to 2.2 mmol/l, which provoked an awakening response in most healthy control participants, did not provoke awakening in most patients with T1DM. On a control night, with no hypoglycemia, none of the participants from either group awakened. The researchers also looked at hormonal changes and found that in all the study participants from both groups who woke up, and in five of the study participants who did not awaken (three T1DM patients and two healthy control participants), plasma epinephrine concentration increased with hypoglycemia by at least 100%. In all participants who awakened increases in epinephrine always started before polysomnographic signs of wakefulness.

These results suggest that the awakening response to hypoglycemia is impaired in T1DM patients. It appears that awakening forms part of a central nervous system response to hypoglycemia and that failure to awaken increases the risk for T1DM patients to suffer prolonged hypoglycemia.

In a related perspective Harry Shamoon and Ilan Gabriely, from the Albert Einstein College of Medicine, discuss the paper further and conclude although further work is need to investigate the precise mechanisms involved, it “strongly supports and further advances the current notion of T1DM susceptibility to nocturnal hypoglycemia”

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EMBARGO: MONDAY, 26 February, 5 P.M. PDT

Everything published by PLoS Medicine is Open Access: freely available for anyone to read, download, redistribute and otherwise use, as long as the authorship is properly attributed.

Please mention PLoS Medicine in your report and use the links below to take your readers straight to the online articles:

Citation: Schultes B, Jauch-Chara K, Gais S, Hallschmid M, Reiprich E, et al. (2007) Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med 4(2): e69.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE
VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040069

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-02-schultes.pdf

Related image for press use: http://www.plos.org/press/plme-04-02-schultes.jpg

- Caption: Physiological responses to insulin-induced hypoglycemia during human sleep (Photograph: Natalie Kriwy)

CONTACT:

Dr. Bernd Schultes

University of Luebeck

Department of Internal Medicine I

Ratzeburger Allee 160

Luebeck 23538 ,

schultes@kfg.uni-luebeck.de

Related PLoS Medicine Perspective article:

Citation: Gabriely I, Shamoon H (2007) Awakening from sleep and hypoglycemia in type 1 diabetes mellitus. PLoS Med 4(2): e99.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040099

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-02-gabriely.pdf

CONTACT:
Ilan Gabriely
Albert Einstein College of Medicine
Department of Medicine and Diabetes Research Center
New York, United States of America
gabriely@aecom.yu.edu



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