OBJECTIVE: To determine the effects of glycemic control on the counterregulatory responses to @entity4053 in @entity164 2 @entity6 . RESEARCH DESIGN AND METHODS: Seven poorly controlled @entity164 2 @entity6 @entity1 (mean HbA1c, 11.3 +/- 1.1%) were studied by stepped hyperinsulinemic hypoglycemic clamp (nadir, 2.4 mmol/l) before and after improving glycemic control with insulin treatment. Counterregulatory hormones, symptoms, and four-choice reaction time were measured at each @entity413 plateau. RESULTS: In @entity1 with poorly controlled @entity164 2 @entity6 , counterregulatory hormone responses began at higher plasma @entity413 levels than did those in healthy subjects ( @entity1425 , 4.4 +/- 0.2 vs. 3.7 +/- 0.2 mmol/l, P = 0.011). After significant improvement in glycemic control (mean HbA1c, 8.1 +/- 0.9%, P < 0.001) was achieved without severe @entity4053 , hormonal responses started at much lower plasma @entity413 levels (e.g., epinephrine, 3.5 +/- 0.3 mmol/l, P = 0.005) and were significantly reduced in magnitude (e.g., area under epinephrine response curve, 306 +/- 93 vs. 690 +/- 107 nmol.min-1.l-1, P = 0.012). This was accompanied by a change in the plasma @entity413 threshold at which hypoglycemic symptoms first developed from 3.6 +/- 0.2 to 3.0 +/- 0.2 mmol/l (P = 0.019). In contrast, the plasma @entity413 threshold at which four-choice reaction time deteriorated did not change significantly (3.1 +/- 0.1 vs. 2.9 +/- 0.1 mmol/l, P = 0.125). CONCLUSIONS: Counterregulatory responses begin at normoglycemia in poorly controlled @entity164 2 @entity6 . Improving glycemic control with insulin therapy normalizes hormonal responses but lowers the plasma @entity413 levels at which hypoglycemic symptoms develop to levels associated with impairment of four-choice reaction time, a marker of cognitive function. This process potentially increases the risk of severe @entity4053 , but to a lesser extent than occurs in @entity164 1 disease.

Effects of glycemic control on protective responses against @entity4053 in XXXX 2 @entity6 .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes'] @entity1425 :: ('MESH:D004837', 'Chemical') :: ['epinephrine'] @entity4053 :: ('MESH:D007003', 'Disease') :: ['hypoglycemia'] @entity164 :: ('MESH:D017827', 'Disease') :: ['type'] @entity413 :: ('MESH:D005947', 'Chemical') :: ['glucose']
@entity164 :: (MESH:D017827,Disease) :: ['type']
