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Type: Journal article
Title: Acceleration of gastric emptying by insulin-induced hypoglycemia is dependent on the degree of hypoglycemia
Author: Murthy, T.A.
Grivell, J.
Hatzinikolas, S.
Chapple, L.-A.S.
Chapman, M.J.
Stevens, J.E.
Malbert, C.-H.
Rayner, C.K.
Horowitz, M.
Jones, K.L.
Marathe, C.S.
Citation: Journal of Clinical Endocrinology and Metabolism, 2021; 106(2):364-371
Publisher: Oxford University Press
Issue Date: 2021
ISSN: 0021-972X
Statement of
Tejaswini Arunachala Murthy, Jacqueline Grivell, Seva Hatzinikolas, Lee-anne S Chapple, Marianne J Chapman, Julie E Stevens, Charles-Henri Malbert, Christopher K Rayner, Michael Horowitz, Karen L Jones, and Chinmay S Marathe
Abstract: Context: Hypoglycemia is a major barrier to optimal glycemic control in insulin-treated diabetes. Recent ADA guidelines have sub-categorized 'non-severe' hypoglycemia into level 1 (<3.9 mmol/L) and 2 (<3 mmol/L) hypoglycemia. Gastric emptying of carbohydrate is a major determinant of postprandial glycemia but its role in hypoglycemia counter-regulation remains under-appreciated. 'Marked' hypoglycemia (~2.6mmol/L) accelerates gastric emptying and increases carbohydrate absorption in health and type 1 diabetes, but the impact of 'mild' hypoglycemia (3.0-3.9mmol/L) is unknown. Objective: To determine the effects of two levels of hypoglycemia, 2.6mmol/L ('marked') and 3.6mmol/L ('mild'), on gastric emptying in health. Design, Setting and Subjects: Fourteen healthy male participants (mean age: 32.9 ± 8.3 years, BMI: 24.5 ± 3.4 kg/m 2) from the general community underwent measurement of gastric emptying of a radiolabeled solid meal (100g beef) by scintigraphy over 120 min on 3 separate occasions, while blood glucose was maintained at either ~2.6mmol/L, ~3.6mmol/L, or ~6 mmol/L in random order from 15 min before until 60 min after meal ingestion using glucose-insulin clamp. Blood glucose was then maintained at 6mmol/L between 60-120 min on all days. Results: Gastric emptying was accelerated during both mild (P=0.011) and marked (P=0001) hypoglycemia when compared to euglycemia, and was more rapid during marked, when compared to mild, hypoglycemia (P=0.008). Hypoglycemia-induced gastric emptying acceleration during mild (r=0.57, P=0.030) and marked (r=0.76, P=0.0014) hypoglycemia was related to gastric emptying during euglycemia. Conclusion: In health, acceleration of gastric emptying by insulin-induced hypoglycemia is dependent on the degree of hypoglycemia and baseline rate of emptying.
Keywords: Hypoglycemia; gastric emptying; counter-regulation of hypoglycemia
Rights: © The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail:
DOI: 10.1210/clinem/dgaa854
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