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Ferdinando Nicoletti - One of the best experts on this subject based on the ideXlab platform.
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effects of octreotide on glycaemic control glucose disposal hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes Research and Clinical Practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, Le R Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P<0.005) and also diminished HGP during an euglycaemic clamp (P<0.05). However, insulin stimulated global glucose uptake remained unchanged. GH, glucagon, IGF-I, IGFBP-3 levels, were significantly lowered by octreotide in both type 1 and type 2 diabetic patients whereas cortisol and epinephrine remained unmodified. Moreover in type 2 diabetic patients both basal (P<0.05) and after-meal (P<0.01) C-peptide secretion was reduced by octreotide. These data point to different metabolic effects of octreotide in type 1 versus type 2 diabetic patients with the drug only being able to reduce glycaemic values and HGP in the former but not in the latter subjects. The failure of octreotide to diminish glycaemic values and HGP in type 2 diabetic patients in spite of its ability to lower GH and glucagon may probably depend on temporary blockage of residual endogenous insulin secretion induced by octreotide administration.
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Effects of octreotide on glycaemic control, glucose disposal, hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes research and clinical practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, R. Le Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P
Robert S. Sherwin - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL ARTICLE Small Decrements in Systemic Glucose Provoke Increases in Hypothalamic Blood Flow Prior to the Release of Counterregulatory Hormones
2013Co-Authors: Jagriti Arora, Maolin Qiu, Rachna Relwani, Todd R. Constable, Robert S. SherwinAbstract:OBJECTIVE—The hypothalamus is the central brain region responsible for sensing and integrating responses to changes in circulating glucose. The aim of this study was to determine the time sequence relationship between hypothalamic activation and the initiation of the Counterregulatory hormonal response to small decrements in systemic glucose. RESEARCH DESIGN AND METHODS—Nine nondiabetic volunteers underwent two hyperinsulinemic clamp sessions in which pulsed arterial spin labeling was used to measure regional cerebral blood flow (CBF) at euglycemia (�95 mg/dl) on one occasion and as glucose levels were declining to a nadir of �50 mg/dl on another occasion. Plasma glucose and Counterregulatory Hormones were measured during both study sessions. RESULTS—CBF to the hypothalamus significantly increased when glucose levels decreased to 77.2 � 2 mg/dl compared wit
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Small Decrements in Systemic Glucose Provoke Increases in Hypothalamic Blood Flow Prior to the Release of Counterregulatory Hormones
Diabetes, 2008Co-Authors: Kathleen A. Page, Jagriti Arora, Maolin Qiu, Rachna Relwani, R. Todd Constable, Robert S. SherwinAbstract:OBJECTIVE— The hypothalamus is the central brain region responsible for sensing and integrating responses to changes in circulating glucose. The aim of this study was to determine the time sequence relationship between hypothalamic activation and the initiation of the Counterregulatory hormonal response to small decrements in systemic glucose. RESEARCH DESIGN AND METHODS— Nine nondiabetic volunteers underwent two hyperinsulinemic clamp sessions in which pulsed arterial spin labeling was used to measure regional cerebral blood flow (CBF) at euglycemia (∼95 mg/dl) on one occasion and as glucose levels were declining to a nadir of ∼50 mg/dl on another occasion. Plasma glucose and Counterregulatory Hormones were measured during both study sessions. RESULTS— CBF to the hypothalamus significantly increased when glucose levels decreased to 77.2 ± 2 mg/dl compared with the euglycemic control session when glucose levels were 95.7 ± 3 mg/dl ( P = 0.0009). Hypothalamic perfusion was significantly increased before there was a significant elevation in Counterregulatory Hormones. CONCLUSIONS— Our data suggest that the hypothalamus is exquisitely sensitive to small decrements in systemic glucose levels in healthy, nondiabetic subjects and that hypothalamic blood flow, and presumably neuronal activity, precedes the rise in Counterregulatory Hormones seen during hypoglycemia.
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Gin and tonic and reactive hypoglycemia : What is important-the gin, the tonic, or both?
The Journal of Clinical Endocrinology and Metabolism, 1998Co-Authors: D Flanagan, Peter J. Wood, Robert S. Sherwin, Kwasi Debrah, David KerrAbstract:The objectives of this study were to test the hypothesis that alcohol can cause reactive hypoglycemia by attenuating the release of Counterregulatory Hormones. The subjects were eight healthy volunteers (five men and three women, aged 20–40 yr). Each subject drank, using a randomized, double blind design 1) three large gin with regular tonics (0.5 g/kg alcohol and 60 g carbohydrate, mainly sucrose (G+T); 2) the same amount of alcohol with Slim-line tonic (0.5 g carbohydrate; G alone); and 3) regular tonic without alcohol (T alone). Glucose, insulin, and Counterregulatory hormone levels and middle cerebral artery velocity (MCAV), an index of cerebral blood flow, were measured. Alcohol levels averaged 60–70 mg/dL. Peak insulin levels were similar in both studies in which regular tonic was consumed (95% confidence interval for difference, −6 to 22 μU/mL). After the ingestion of G+T, the blood glucose nadir was lower compared to that with T alone (3.35 vs. 3.87 mmol/L; P < 0.02) or G alone (3.35 vs. 3.95 mmol...
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Local Ventromedial Hypothalamus Glucopenia Triggers Counterregulatory Hormone Release
Diabetes, 1995Co-Authors: Walter P. Borg, Robert S. Sherwin, Matthew J. During, Monica A. Borg, Gerald I. ShulmanAbstract:To test the hypothesis that nuclei of the ventromedial hypothalamus (VMH) play a key role in the detection of Counterregulatory responses to hypoglycemia, we delivered the glucopenic agent 2-deoxyglucose via bilaterally placed microdialysis probes into the VMH of conscious, chronically catheterized rats. The goal was to produce cellular glucopenia localized to the VMH. The volume of brain tissue exposed to 2-deoxyglucose was determined by adding [3H]2-deoxyglucose to the dialysate; its distribution in cerebral tissue was almost exclusively limited to the VMH. Rats with microdialysis probes placed into the frontal lobes served as a control group. Local perfusion of 2-deoxyglucose (but not glucose) into the VMH caused a prompt twofold increase in plasma glucose in association with a striking elevation of plasma glucagon (3.5-fold), epinephrine (30-fold), and norepinephrine (3.5-fold). No effect was seen when 2-deoxyglucose was delivered into the frontal lobes. We conclude that glucopenia localized to the VMH triggers the release of Counterregulatory Hormones that defend against hypoglycemia. Thus, the neurons that sense glucopenia may be situated in the VMH.
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Influence of Counterregulatory Hormones, independently of hypoglycaemia, on cognitive function, warning symptoms and glucose kinetics.
Clinical science (London England : 1979), 1993Co-Authors: David Kerr, Michael P. Diamond, William V. Tamborlane, Sara Kerr, Robert S. SherwinAbstract:1. To assess the influence of Counterregulatory Hormones, independently of neuroglycopaenia, on higher cerebral (cognitive) function, 'hypoglycaemic' warning symptoms and glucose kinetics, 10 healthy subjects participated in two hyperinsulinaemic (2 m-units min-1 kg-1) glucose clamp studies. After 100 min of euglycaemia (plasma glucose level 5 mmol/l), the plasma glucose level was either (a) maintained at 5 mmol/l for 120 min by glucose infusion with concomitant replacement of Counterregulatory Hormones (continuous infusions of glucagon, adrenaline, noradrenaline, cortisol and growth hormone) to mimic the hormonal milieu normally associated with hypoglycaemia (hormone infusion study) or (b) lowered to 2.8 mmol/l for 120 min (hypoglycaemia study). Assessments were made of cognitive function (P300 auditory evoked responses), symptoms (visual analogue scales) and glucose kinetics (3-[3H]glucose). 2. Hypoglycaemia was associated with an increase in all symptoms (facial flushing, palpitations, tingling, trembling, sweating, hunger, light-headedness and sleepiness, P < 0.01) and all subjects were aware that blood glucose levels had fallen. P300 evoked potential latency increased from 280 +/- 6 to 312 +/- 5 ms (mean +/- SEM, P < 0.01). In contrast, P300 latency and several individual symptoms (hunger, facial flushing, sweating and light-headedness) did not change from baseline during the hormone infusion study (P < 0.05 versus hypoglycaemia). Hepatic glucose production was lower (1.5 +/- 0.4 versus 2.3 +/- 0.3 mg min-1 kg-1, P < 0.05) and peripheral glucose uptake was higher (7.4 +/- 1.0 versus 5.6 +/- 0.6 mg min-1 kg-1, P < 0.01) during infusion of the Hormones compared with during hypoglycaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Michele Lunetta - One of the best experts on this subject based on the ideXlab platform.
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effects of octreotide on glycaemic control glucose disposal hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes Research and Clinical Practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, Le R Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P<0.005) and also diminished HGP during an euglycaemic clamp (P<0.05). However, insulin stimulated global glucose uptake remained unchanged. GH, glucagon, IGF-I, IGFBP-3 levels, were significantly lowered by octreotide in both type 1 and type 2 diabetic patients whereas cortisol and epinephrine remained unmodified. Moreover in type 2 diabetic patients both basal (P<0.05) and after-meal (P<0.01) C-peptide secretion was reduced by octreotide. These data point to different metabolic effects of octreotide in type 1 versus type 2 diabetic patients with the drug only being able to reduce glycaemic values and HGP in the former but not in the latter subjects. The failure of octreotide to diminish glycaemic values and HGP in type 2 diabetic patients in spite of its ability to lower GH and glucagon may probably depend on temporary blockage of residual endogenous insulin secretion induced by octreotide administration.
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Effects of octreotide on glycaemic control, glucose disposal, hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes research and clinical practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, R. Le Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P
M. Di Mauro - One of the best experts on this subject based on the ideXlab platform.
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effects of octreotide on glycaemic control glucose disposal hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes Research and Clinical Practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, Le R Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P<0.005) and also diminished HGP during an euglycaemic clamp (P<0.05). However, insulin stimulated global glucose uptake remained unchanged. GH, glucagon, IGF-I, IGFBP-3 levels, were significantly lowered by octreotide in both type 1 and type 2 diabetic patients whereas cortisol and epinephrine remained unmodified. Moreover in type 2 diabetic patients both basal (P<0.05) and after-meal (P<0.01) C-peptide secretion was reduced by octreotide. These data point to different metabolic effects of octreotide in type 1 versus type 2 diabetic patients with the drug only being able to reduce glycaemic values and HGP in the former but not in the latter subjects. The failure of octreotide to diminish glycaemic values and HGP in type 2 diabetic patients in spite of its ability to lower GH and glucagon may probably depend on temporary blockage of residual endogenous insulin secretion induced by octreotide administration.
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Effects of octreotide on glycaemic control, glucose disposal, hepatic glucose production and Counterregulatory Hormones secretion in type 1 and type 2 insulin treated diabetic patients
Diabetes research and clinical practice, 1997Co-Authors: Michele Lunetta, M. Di Mauro, R. Le Moli, Ferdinando NicolettiAbstract:We studied the effects of continuous subcutaneous infusion of octreotide (100 μg/day for 5 days) on glycaemic values, Counterregulatory Hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P
Jannik Hilsted - One of the best experts on this subject based on the ideXlab platform.
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Counterregulatory Hormones in insulin treated diabetic patients admitted to an accident and emergency department with hypoglycaemia
Diabetic Medicine, 1998Co-Authors: A. Hvidberg, Juel N Christensen, Jannik HilstedAbstract:The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and Counterregulatory Hormones were measured before and 30-120 min after treatment. Pre-treatment Counterregulatory hormone concentrations were significantly lower than hormone concentrations during induced hypoglycaemia in healthy control subjects but significantly higher than healthy fasting concentrations for plasma adrenaline (p = 0.020), glucagon (p = 0.008), growth hormone (p = 0.011), and cortisol (p<0.00001). Thus, although glucagon and adrenaline responses may be absent when studying Type 1 diabetic patients in the experimental setting, both Hormones increase to a significant extent in 'real-life' hypoglycaemia in this patient group, although to a lesser degree than might be expected. Plasma glucose did not differ significantly between the two treatments at any time point. Despite access to food, one of four patients in group B and one of five patients in group A had plasma glucose below 4.0 mmol l(-1) after 120 min. In conclusion, low yet significantly elevated concentrations of adrenaline and glucagon were found in diabetic patients admitted with severe hypoglycaemia to an Accident and Emergency Department.
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Counterregulatory Hormones in insulin-treated diabetic patients admitted to an accident and emergency department with hypoglycaemia.
Diabetic medicine : a journal of the British Diabetic Association, 1998Co-Authors: A. Hvidberg, N. Juel Christensen, Jannik HilstedAbstract:The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and Counterregulatory Hormones were measured before and 30-120 min after treatment. Pre-treatment Counterregulatory hormone concentrations were significantly lower than hormone concentrations during induced hypoglycaemia in healthy control subjects but significantly higher than healthy fasting concentrations for plasma adrenaline (p = 0.020), glucagon (p = 0.008), growth hormone (p = 0.011), and cortisol (p
