A test of the hypothesis that the rate of fall in glucose concentration triggers counterregulatory hormonal responses in man

The hypothesis that the rate of fall in glucose concentration triggers counterregulatory hormonal responses was tested in 5 subjects following 1 hr of sustained hyperglycemia. Despite a rapidly falling blood glucose concentration, no increase in plasma growth hormone, cortisol, glucagon, or catecholamines occurred as long as the blood glucose concentration remained above fasting levels. Plasma growth hormone, cortisol, and catecholamines were not released until the mean blood glucose reached 28 mg/100 ml, 39 mg/100 ml, and 39 mg/100 ml, respectively, below the fasting level. Plasma glucagon was suppressed during the period of hyperglycemia. As the blood glucose concentration fell below basal levels, a progressive increase in glucagon occurred. Plasma glucagon returned to fasting values when the nadir in blood glucose was attained. During the period of rapidly falling blood glucose, only plasma insulin showed any change; its response lagged behind the decline in blood glucose. By the time the fasting glucose level was attained, the plasma insulin was still almost 3 times the basal level. The authors concluded that under their experimental conditions the rate of fall in blood glucose and the degree of hypoglycemia achieved are primarily determined by the plasma insulin concentration.