Epinephrine Secretion, Hypoglycemia Unawareness, and Diabetic Autonomic Neuropathy

The pathophysiology of latrogenic hypoglycemia in patients with insulin-dependent diabetes mellitus has been studied extensively during the past decade. It is now widely recognized that some patients with long-standing diabetes lose their ability to secrete the major counterregulatory hormones, glucagon and epinephrine, and fail to have hypoglycemia-related autonomic warning symptoms. Many investigators focused initially on the role of autonomic neuropathy, assuming that the latter might explain the diminished epinephrine response to hypoglycemia and the blunted adrenergic warning signs