Hormonal, subjective, and neurocognitive responses to brief hypoglycemia in postmenopausal women and age-matched men with type 2 diabetes mellitus

Bremer, Jan Phillip; Baron, Maria; Peters, Horst; Oltmanns, Kerstin M.; Kern, Werner; Fehm, Horst L.; Born, Jan; Schultes, Bernd

doi:10.1016/j.metabol.2005.09.006

« Previous Next »Metabolism - Clinical and Experimental
Volume 55, Issue 3 , Pages 331-338, March 2006

Hormonal, subjective, and neurocognitive responses to brief hypoglycemia in postmenopausal women and age-matched men with type 2 diabetes mellitus

Jan Phillip Bremer
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
Maria Baron
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
Horst Peters
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
Kerstin M. Oltmanns
- Department of Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany
Werner Kern
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
Horst L. Fehm
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
Jan Born
- Department of Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany
Bernd Schultes
- Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany
- Corresponding author. Tel.: +49 451 500 3639; fax: +49 451 500 3640.

Received 15 March 2006; accepted 22 September 2006.

Abstract

Sexual dimorphisms in hypoglycemic counterregulation are well documented in young healthy and type 1 diabetic subjects. Here, we questioned whether sex differences in counterregulation are present also in type 2 diabetic patients who are in a postmenopausal state. In an attempt to answer this question, we examined hormonal responses to a single-step hypoglycemic clamp (50 mg/dL) in 15 postmenopausal women and 15 age-matched men. Patients were also matched for body mass index, HbA_1c, diabetes duration, and diabetes therapy. In addition to hormonal counterregulation, perception of symptoms as well as aspects of neurocognitive function (short-term memory of words and reaction time on an auditory vigilance task) was assessed at baseline and during the hypoglycemic clamp. Hypoglycemia induced a profound rise in almost all counterregulatory hormones, that is, epinephrine, norepinephrine, corticotropin, cortisol, and growth hormone (all P < .007), except for glucagon, which slightly decreased (P = .014). However, none of the responses differed between sexes (all P > .256). In addition, perceived symptoms (P < .001) as well as reaction time on the vigilance task (P < .001) increased, and short-term memory performance tended to deteriorate (P = .091) during hypoglycemia. Again these changes did not differ between the sexes (all P > .370). In sum, data suggest that, in contrast to previous observations in young, healthy, and type 1 diabetic subjects, sex does not represent an important determinant of hormonal, subjective, and neurocognitive responses to hypoglycemia in postmenopausal type 2 diabetic patients. However, the women in our study were all postmenopausal and not receiving hormone replacement therapy. Therefore, our results cannot be generalized to female patients with type 2 diabetes who are premenopausal or on hormone replacement therapy, that is, conditions characterized by increased blood estrogen levels.