Counter-regulatory hormone response to hypoglycaemia (glucagon, adrenaline, cortisol, GH)
Core concept
- A hierarchy of defences, each with its own glucose threshold
| BSL (mmol/L) | Response |
|---|---|
| 4.4-4.7 | dec insulin secretion - the first defence |
| 3.6-3.9 | inc GLUCAGON - the primary counter-regulatory hormone |
| 3.6-3.8 | inc ADRENALINE - the critical back-up when glucagon fails |
| 3.0-3.2 | inc cortisol and growth hormone - slower, matter after 4-6 h |
| 3.0-3.2 | Autonomic warning symptoms |
| <2.8 | Neuroglycopenic symptoms, cognitive impairment |
| <1.5 | Seizure, coma, death |
- Glucagon - inc hepatic glycogenolysis and gluconeogenesis; acts within minutes; the dominant acute defence
- Adrenaline - inc hepatic glucose output, inc lipolysis and muscle glycogenolysis, dec peripheral glucose uptake, dec insulin secretion; also generates the warning symptoms
- Cortisol and GH - permissive and sustaining: inc gluconeogenesis, inc lipolysis, dec peripheral uptake; matter in prolonged fasting and in adrenal insufficiency, not in acute hypoglycaemia
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