RSS-Feed abonnieren
DOI: 10.1055/s-2007-993143
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Effect of Experimentally Induced Hypoglycemia and Different Insulin Levels on Feelings of Hunger in Type 1 Diabetic Patients
Publikationsverlauf
received 12.07.2007
first decision 17.09.2007
accepted 31.10.2007
Publikationsdatum:
19. Mai 2008 (online)

Abstract
Introduction: This study investigates the impacts of experimentally induced hypoglycemia and different insulin infusion rates on feelings of hunger.
Methods: Blood glucose and insulin levels were manipulated by hyperinsulinemic glucose clamp technique. Participants were 16 patients with type 1 diabetes (age 36.2±11.7 yrs, diabetes duration 9.0±6.3 yrs, HbA1c 8.2±2.0%). One group (n=8) received moderate, constant insulin infusion (0.8 μU/kg/min), whereas the insulin infusion was doubled in the other group (1.6 μU/kg/min). Blood glucose was lowered stepwise from euglycemia (5.6 mmol/l) to moderate hypoglycemia (2.5 mmol/l).
Results: As expected, there was a significant effect of hypoglycemia on feelings of hunger (F (3, 42)=41.7, p<0.01). But during high insulin infusion, feelings of hunger were significantly less intense than during moderate insulin infusion (F (1, 14)=7.2, p=0.02).
Conclusion: Peripheral insulin levels seem to be associated with the intensity of feelings of hunger.
Key words
insulin - hunger regulation - regulation of energy homeostasis - hypoglycemia - type 1 diabetes
References
- 1 Hill JO, Catenacci V, Wyatt HR. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2005; VII 28:1-2823
- 2 Haslam DW, James WP. Obesity. Lancet. 2005; 366 1197-1209
- 3 Porte Jr D, Baskin DG, Schwartz MW. Insulin signaling in the central nervous system: a critical role in metabolic homeostasis and disease from C. elegans to humans. Diabetes. 2005; 54 1264-1276
- 4 Schwartz MW, Porte Jr D. Diabetes, obesity, and the brain. Science. 2005; 307 375-379
- 5 Boyle PJ, Nagy RJ, OŽConnor AM, Kempers SF, Yeo RA, Qualls C. Adapation in brain glucose uptake following recurrent hypoglycemia. Proceedings of the National Academy of Science, USA. 1994; 91 9352-9356
- 6 Boyle PJ, Kempers SF, OŽConnor AM, Nagy RJ. Brain glucose uptake and unawareness of hypoglycemia in patients with insulin dependent diabetes. New England Journal of Medicine. 1995; 333 1726-1731
- 7 Biggers DW, Myers S, Neal D, Stinson R, Cooper NB, Jaspan JB, Williams PE, Cherrington AD, Frizzell RT. Role of brain in counterregulation of insulin induced hypoglycemia in dogs. Diabetes. 1989; 37 7-16
- 8 Mitrakou A, Ryan C, Veneman T, Mokan M, Jensen T, Kiss I, Durrant J, Cryer P, Gerich J. Hierarchy of glycemic tresholds for counterregulatory hormone secretion, symptoms and cerebral dysfunction. Journal of Physiology. 1991; 260 E67-E74
- 9 Cryer P, Davis ND, Shamoon H. Hypoglycemia in Diabetes. Diabetes Care. 2003; 26 1902-1912
-
10 Frier BM, Fisher BM. Impaired hypoglycaemia awareness. In: Frier BM, Fisher BM, Eds.
Hypoglycaemia in clinical diabetes . New York, Wiley & Sons 1999: 111-146 - 11 Seaquist ER, Damberg GS, Tkac I, Gruetter R. The effect of insulin on in vivo cerebral glucose concentrations and rates of glucose transport/metabolism in humans. Diabetes. 2001; 50 2203-2209
- 12 Schwartz MW, Figlewicz DP, Baskin DG, Woods SC, Porte Jr D. Insulin in the brain: a hormonal regulator of energy balance. Endocr Rev. 1992; 13 387-414
- 13 Woods SC, Lotter EC, MacKay LD, Porte Jr D. Chronic intracerebroventricular infusion of insulin reduces food intake and body weight of baboons. Nature. 1979; 282 503-505
- 14 Bruning JC, Gautam D, Burks DJ, Gillette J, Schubert M, Orban PC, Klein R, Krone W, Muller-Wieland D, Kahn CR. Role of brain insulin receptor in control of body weight and reproduction. Science. 2000; 289 2122-2125
- 15 Heine RJ. Methods of investigation of insulin induced hypoglycemia. In Hypoglycemia and Diabetes. Frier BM, Fisher BM, Eds London, Edward Arnold 1993: 165-175
- 16 Pais I, Hallschmid M, Jauch-Chara K, Schmid SM, Oltmanns KM, Peters A, Born J, Schultes B. Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients. Exp Clin Endocrinol Diabetes. 2007; 115 42-46
- 17 Fronzo RA De, Tobin JD, Andres R. Glucose Clamp technique: a method for quantifying insulin secretion and resistance. American Journal of Preventive Medicine. 1979; 6 E214-E223
- 18 Liu D, Moberg E, Kollind M, Lins P E, Adamson U, Macdonald IA. Arterial, arterialized venous and capillary blood glucose measurements in normal man during hyperinsulinaemic euglyccaemia and hypoglycaemia. Diabetologia. 1992; 35 287-290
- 19 Hepburn DA, Deary IJ, Frier BM, Patrick AW, Quinn JD, Fisher BM. Symptoms of acute hypoglycemia in humans with and without IDDM. Diabetes Care. 1991; 14 949-957
- 20 Fletcher AA, Campbell BM. The blood sugar following insulin administration and the symptom complex - hypoglycemia. J Metab Res. 1922; 2 637-649
-
21 Cryer PE.
Hypoglycemia: Pathophysiology, diagnosis, and treatment . Oxford, Oxford Press 1997 - 22 Schwartz NS, Clutter WE, Shah WE, Cryer PE. Glycemic tresholds for activiation of glucose counterregulatory systems are higher than the tresholds for symptoms. Journal of Clinical Investigation. 1987; 79 777-781
- 23 Kotz CM, Briggs JE, Grace MK, Levine AS, Billington CJ. Divergence of the feeding and thermogenic pathways influenced by NPY in the hypothalamic PVN of the rat. Am J Physiol. 1998; 275 R471-R477
- 24 Pliquett RU, Fuhrer D, Falk S, Zysset S, Cramon DY von, Stumvoll M. The effects of insulin on the central nervous system-focus on appetite regulation. Horm Metab Res. 2006; 38 442-446
- 25 Ollmann MM, Lamoreux ML, Wilson BD, Barsh GS. Interaction of Agouti protein with the melanocortin 1 receptor in vitro and in vivo. Genes Dev. 1998; 12 316-330
- 26 Schwartz MW, Woods SC, Porte Jr D, Seeley RJ, Baskin DG. Central nervous system control of food intake. Nature. 2000; 404 661-671
- 27 Kern W, Peters A, Fruehwald-Schultes B, Deininger E, Born J, Fehm HL. Improving influence of insulin on cognitive functions in humans. Neuroendocrinology. 2001; 74 270-280
- 28 Hallschmid M, Benedict C, Schultes B, Fehm HL, Born J, Kern W. Intranasal insulin reduces body fat in men but not in women. Diabetes. 2004; 53 3024-3029
- 29 Galassetti P, Davis SN. Effects of insulin per se on neuroendocrine and metabolic counter-regulatory responses to hypoglycaemia. Clin Sci (Lond). 2000; 99 351-362
-
30 Thomas L.
Labor und Diagnose . Frankfurt am Mein, Th. Books-Verlag 2005
Correspondence
Dr. N. Hermanns
Forschungsinstitut der Diabetes Akademie Bad Mergentheim (FIDAM)
Postfach 1144
97961 Bad Mergentheim
Germany
eMail: Hermanns@diabetes-zentrum.de