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Diabetes

Hypoglycemia & Adrenaline

07/21/2003

Question:

What is the connection between Hypoglycemia and overproduction of adrenaline? Is it true that when blood sugar drops from too much insulin, the body also produces too much adrenaline in response? If it is true, how long does that last and why?

Answer:

Hypoglycemia, a low blood sugar, is a severe stress to the human body. To combat that stress, the body has a number of mechanisms to raise the blood sugar back towards normal. In fact, they sometimes overshoot, resulting in a high blood sugar. Adrenaline is one name for a hormone also called epinephrine made in the middle (inside portion) of the adrenal gland, the adrenal medulla. Release of epinephrine is one of those mechanisms to combat low blood sugars. Epinephrine`s actions include speeding up the heart rate, increasing heart pumping effectiveness, opening up airways and increasing attentiveness, that are valuable in stressful or dangerous situations. Nervousness or jitteriness can result from epinephrine release. The other hormone which is important early in the response to hypoglycemia is called glucagon and that comes from islet cells in the pancreas adjacent to those which produce insulin. Two other hormones, cortisol (produced in the outer part of the adrenal, the adrenal cortex) and growth hormone (produced in the pituitary gland), have actions which are important in preparing for hypoglycemia over the long term, hours to days - essentially having the system primed for the "next" possible episode. These mechanisms could be set off no matter what causes hypoglycemia, whether it is too much insulin, too much exercise out of proportion to the food eaten, or a missed meal. The effects of the epinephrine last minutes to hours. Clearly, it is good that we have these mechanisms. If a person without known diabetes starts having recurrent episodes that feel like these kind of spells, it may be worth looking into. For many people, they can be resolved by a simple change in diet or lifestyle routine or perhaps elimination of some nutritional supplements. Others may need further tests to figure out whether this represents a disease. In people with diabetes, frequent or recurrent hypoglycemic episodes also bear looking into to figure out whether some change in medicines, diet or lifestyle might prevent future episodes. Most hypoglycemic spells are not associated with dangerous outcomes. But it is important to recognize that there is a range of severity and some can be extremely dangerous, even causing accidents and death. So it is important to respect the risk associated with them.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati