Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes
Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes Minna L. Koivikko 1 , Pasi I. Salmela 1 , K.E. Juhani Airaksinen 2 , Juha S. Tapanainen 3 , Aimo Ruokonen 4 , Timo H. Mäkikallio 1 and Heikki V. Huikuri 1 1 Department of Internal Medicine, Un...
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| Published in: | Diabetes (New York, N.Y.) Vol. 54; no. 3; pp. 744 - 750 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Alexandria, VA
American Diabetes Association
01.03.2005
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| ISSN: | 0012-1797, 1939-327X |
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| Abstract | Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes
Minna L. Koivikko 1 ,
Pasi I. Salmela 1 ,
K.E. Juhani Airaksinen 2 ,
Juha S. Tapanainen 3 ,
Aimo Ruokonen 4 ,
Timo H. Mäkikallio 1 and
Heikki V. Huikuri 1
1 Department of Internal Medicine, University of Oulu, Oulu, Finland
2 Department of Internal Medicine, University of Turku, Turku, Finland
3 Department of Gynecology and Obstetrics, University of Oulu, Oulu, Finland
4 Department of Clinical Chemistry, University of Oulu, Oulu, Finland
Address correspondence and reprint requests to Heikki Huikuri, MD, Department of Internal Medicine, University of Oulu, P.O.
Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Finland. E-mail: heikki.huikuri{at}oulu.fi
Abstract
Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study
assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic
patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy
control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was
measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincaré plot analysis
during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5–5.5, 3.0–3.5, and
2.0–2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from
72 ± 9 to 80 ± 11 bpm, P < 0.01) and the control subjects (from 59 ± 5 to 65 ± 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1;
P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude
that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic
regulation may contribute to the occurrence of cardiac events during hypoglycemia.
BP, blood pressure
GH, growth hormone
Footnotes
Accepted November 15, 2004.
Received September 9, 2004.
DIABETES |
|---|---|
| AbstractList | Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincaré plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5–5.5, 3.0–3.5, and 2.0–2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 ± 9 to 80 ± 11 bpm, P < 0.01) and the control subjects (from 59 ± 5 to 65 ± 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia. Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincare plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5-5.5, 3.0-3.5, and 2.0-2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 +/- 9 to 80 +/- 11 bpm, P < 0.01) and the control subjects (from 59 +/- 5 to 65 +/- 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia. Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincare plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5-5.5, 3.0-3.5, and 2.0-2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 +/- 9 to 80 +/- 11 bpm, P < 0.01) and the control subjects (from 59 +/- 5 to 65 +/- 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia.Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincare plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5-5.5, 3.0-3.5, and 2.0-2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 +/- 9 to 80 +/- 11 bpm, P < 0.01) and the control subjects (from 59 +/- 5 to 65 +/- 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia. Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes Minna L. Koivikko 1 , Pasi I. Salmela 1 , K.E. Juhani Airaksinen 2 , Juha S. Tapanainen 3 , Aimo Ruokonen 4 , Timo H. Mäkikallio 1 and Heikki V. Huikuri 1 1 Department of Internal Medicine, University of Oulu, Oulu, Finland 2 Department of Internal Medicine, University of Turku, Turku, Finland 3 Department of Gynecology and Obstetrics, University of Oulu, Oulu, Finland 4 Department of Clinical Chemistry, University of Oulu, Oulu, Finland Address correspondence and reprint requests to Heikki Huikuri, MD, Department of Internal Medicine, University of Oulu, P.O. Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Finland. E-mail: heikki.huikuri{at}oulu.fi Abstract Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincaré plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5–5.5, 3.0–3.5, and 2.0–2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 ± 9 to 80 ± 11 bpm, P < 0.01) and the control subjects (from 59 ± 5 to 65 ± 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia. BP, blood pressure GH, growth hormone Footnotes Accepted November 15, 2004. Received September 9, 2004. DIABETES Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type 1 diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincar6 plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5-5.5, 3.0-3.5, and 2.0-2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 ± 9 to 80 ± 11 bpm, P < 0.01) and the control subjects (from 59 ± 5 to 65 ± 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia. |
| Audience | Professional |
| Author | Minna L. Koivikko Heikki V. Huikuri K.E. Juhani Airaksinen Pasi I. Salmela Juha S. Tapanainen Timo H. Mäkikallio Aimo Ruokonen |
| Author_xml | – sequence: 1 givenname: Minna L surname: Koivikko fullname: Koivikko, Minna L organization: Department of Internal Medicine, University of Oulu, P.O. Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Finland – sequence: 2 givenname: Pasi I surname: Salmela fullname: Salmela, Pasi I – sequence: 3 givenname: K E Juhani surname: Airaksinen fullname: Airaksinen, K E Juhani – sequence: 4 givenname: Juha S surname: Tapanainen fullname: Tapanainen, Juha S – sequence: 5 givenname: Aimo surname: Ruokonen fullname: Ruokonen, Aimo – sequence: 6 givenname: Timo H surname: Mäkikallio fullname: Mäkikallio, Timo H – sequence: 7 givenname: Heikki V surname: Huikuri fullname: Huikuri, Heikki V |
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| Snippet | Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes
Minna L. Koivikko 1 ,
Pasi I. Salmela 1 ,
K.E.... Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of... |
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| SubjectTerms | Adolescent Adult Biological and medical sciences Blood Pressure - drug effects Blood Pressure - physiology Cardiovascular diseases Diabetes Diabetes Mellitus, Type 1 - drug therapy Diabetes Mellitus, Type 1 - physiopathology Diabetes research Diabetes. Impaired glucose tolerance Diagnosis Endocrine pancreas. Apud cells (diseases) Endocrinopathies Female Heart Rate - drug effects Heart Rate - physiology Homeostasis Humans Hyperinsulinism - chemically induced Hyperinsulinism - physiopathology Hypoglycemia - chemically induced Hypoglycemia - physiopathology Insulin - adverse effects Insulin - therapeutic use Male Medical sciences Middle Aged Risk factors Type 1 diabetes |
| Title | Effects of Sustained Insulin-Induced Hypoglycemia on Cardiovascular Autonomic Regulation in Type 1 Diabetes |
| URI | http://diabetes.diabetesjournals.org/content/54/3/744.abstract https://www.ncbi.nlm.nih.gov/pubmed/15734851 https://www.proquest.com/docview/216470226 https://www.proquest.com/docview/67468401 |
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