Action of Other Hormones

When hypoglycaemia is present the body protects itself by:

  • Suppressing endogenous insulin secretion
  • A sequence of counter-regulatory effects

In the acute phase, release of counter regulatory hormones glucagon (from the pancreas), and catecholamines (from the adrenals) stimulate glycogenolysis and gluconeogenesis.

If the liver is unable to response, due to inadequate glycogen stores or liver cell disease, then glucagon is ineffective, and gluconeogenesis will play a greater role.

Young healthy persons (without diabetes) release counter-regulatory hormones are released at blood glucose levels of 3.8 mmol/L, symptoms start usually around 3.0 mmol/L with cognitive dysfunction at levels below 2 mmol/L [5]. However these effects occur at different levels in individuals with diabetes, partly dependent on their previous glycaemic control.

Type 1 diabetes

In type 1 diabetes the endogenous glucagon response to hypoglycaemia reduces or is absent within a few years of diagnosis. However they continue to respond to exogenous glucagon, hence its role in treatment. The catecholamine response may also be attenuated or occur at a lower glucose level producing fewer warning signs and less time to take corrective action.

Type 2 diabetes

In type 2 diabetes glucose counter-regulatory mechanisms are usually preserved during the early years, as is insulin secretion. As insulin deficiency develops, and the patient needs insulin treatment, counter-regulatory mechanisms are impaired. Hypoglycaemia is usually said to be more frequent in type 1 diabetes than type 2, but in patients treated with insulin the rates may be similar [5].