Insulin-Induced Hypoglycemia Accelerates Gastric Emptying of Solids and Liquids in Long-Standing Type 1 Diabetes

• Published in: The journal of clinical endocrinology and metabolism Vol. 90; no. 8; pp. 4489 - 4495
• Main Authors: Russo, Antonietta, Stevens, Julie E., Chen, Richard, Gentilcore, Diana, Burnet, Richard, Horowitz, Michael, Jones, Karen L.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.08.2005
• Subjects: Adult; Biological and medical sciences; Blood Pressure; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Drinking; Eating; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fundamental and applied biological sciences. Psychology; Gallium Radioisotopes; Gastric Emptying - drug effects; Gastric Emptying - physiology; Glucose Clamp Technique; Heart Rate; Humans; Hypoglycemia - chemically induced; Hypoglycemia - etiology; Hypoglycemia - physiopathology; Hypoglycemic Agents - adverse effects; Insulin - adverse effects; Male; Medical sciences; Middle Aged; Technetium; Vertebrates: endocrinology; Endocrinopathy; Stomach; Immunopathology; Pancreatic hormone; Induced hypoglycemia; Digestive system; Type 1 diabetes; Autoimmune disease; Gastric emptying; Insulin; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2005-0513

Context: The rate of gastric emptying of carbohydrate is a major determinant of postprandial glycemia. In healthy subjects and patients with uncomplicated type 1 diabetes, there is evidence that gastric emptying may be accelerated by insulin-induced hypoglycemia. Objective: The objective was to determine the effects of acute hypoglycemia on gastric emptying in long-standing type 1 diabetes and evaluate whether the response to hypoglycemia is influenced by the rate of gastric emptying during euglycemia and/or autonomic dysfunction. Design: Gastric emptying of a solid/liquid meal (100 g 99mTc–minced beef and 150 ml 67Ga-EDTA-labeled water) was measured by scintigraphy on 2 separate days, during hypoglycemia and euglycemia. Setting: These studies took place at the Department of Nuclear Medicine, Positron Emission Tomography, and Bone Densitometry at the Royal Adelaide Hospital. Patients: Twenty type 1 patients (4 female, 16 male; age, 45.9 ± 2.3 yr; duration of known diabetes, 18.0 ± 2.7 yr) were recruited from outpatient clinics and the Diabetes Centre at the Royal Adelaide Hospital. Intervention: Hypoglycemia (∼2.6 mmol/liter) was established 15 min before and maintained for 45 min after meal consumption. On one of the days, autonomic nerve function was evaluated using cardiovascular reflex tests. Main Outcome Measure: The main outcome measure was gastric emptying during hypoglycemia when compared with euglycemia. Results: Twelve of the 20 subjects had autonomic neuropathy. Gastric emptying of both solid (P < 0.001) and liquid (P < 0.05) was faster during hypoglycemia. The magnitude of this acceleration was greater when the rate of gastric emptying during euglycemia was slower (solid, percentage retention at 100 min, r = −0.52, P < 0.05; liquid, 50% emptying time, r = −0.82, P < 0.0001, but not influenced by autonomic nerve function). Conclusions: Insulin-induced hypoglycemia accelerates gastric emptying of solids and liquids in long-standing type 1 diabetes, even in those patients with delayed emptying, and is likely to be an important mechanism in the counter-regulation of hypoglycemia.