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Results show that awakening during hypoglycemia was associated with substantial hormonal changes, …


Biology Articles » Chronobiology » Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus » Figures

Figures
- Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus

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Figure 1. Plasma Glucose Concentration during Insulin-Induced Hypoglycemia

Mean ± standard error of the mean plasma glucose concentration in 16 control participants (open circles) and in 16 patients with T1DM (filled circles) during insulin-induced hypoglycemia and the subsequent 30 min. Grey horizontal bars indicate intervals of wakefulness (determined by polysomnography) in ten out of 16 healthy individuals awakening upon hypoglycemia. The black horizontal line represents time awake for the only T1DM patient who awoke during hypoglycemia. There were no differences (p > 0.45) between T1DM patients and healthy control participants in glucose infusion rates during the 1-h hypoglycemic interval or between the study participants (from either group) who did and did not wake up.

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Figure 2. Sleep, Plasma Glucose, and Epinephrine Concentrations in Five Individuals during Insulin-Induced Hypoglycemia

The panels depict time courses of polysomnographically recorded sleep (black line) in parallel with plasma glucose (green line) and epinephrine (red line) concentrations during the 1-h insulin infusion (0 to 60 min).

(A and B) Data from two healthy control participants who displayed the typical awakening response to hypoglycemia.

(C) Data from a healthy control participant who did not awaken during hypoglycemia and remained in slow-wave sleep (sleep stages 3 and 4).

(D) Data from the only one of the 16 T1DM patients who awakened during hypoglycemia.

(E) Data from a typical T1DM patient who did not awaken during hypoglycemia.

Note that all study participants who woke up (A, B, and D) show marked rises in epinephrine levels that always start before awakening. Note also that awakening occurred fairly abruptly in most cases (e.g., B and D), and was not preceded by a gradual lightening of sleep. (Left x-axis refers to sleep stages—awake and sleep stages 1 to 4).

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Figure 3. Counterregulatory Hormonal Responses during Insulin-Induced Hypoglycemia

Mean ± standard error of the mean counterregulatory hormone concentrations during insulin-induced hypoglycemia in the 16 healthy control participants (open circles) and in the 16 T1DM patients (filled circles).

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