Skip to main content
Erschienen in: Diabetologia 11/2013

01.11.2013 | Article

β2-Adrenergic receptor agonist administration promotes counter-regulatory responses and recovery from hypoglycaemia in rats

verfasst von: Barbara Szepietowska, Wanling Zhu, Robert S. Sherwin

Erschienen in: Diabetologia | Ausgabe 11/2013

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

We have previously reported that local activation of β2-adrenergic receptors (B2ARs) in the ventromedial hypothalamus (VMH) enhances hypoglycaemic counter-regulation. This study examines whether peripheral delivery of a selective B2AR agonist could also promote counter-regulatory responses and thereby has potential therapeutic value to limit hypoglycaemia risk.

Methods

Conscious male Sprague–Dawley rats received an intra-arterial injection of the B2AR specific agonist, formoterol, or a control solution either before a hyperinsulinaemic–hypoglycaemic clamp study or immediately before recovery from insulin-induced hypoglycaemia. In addition, the capacity of a VMH-targeted microinjection of a B2AR antagonist to limit the anti-insulin effect of the B2AR agonist was assessed.

Results

Systemic delivery of B2AR agonist markedly reduced the exogenous glucose infusion rate (GIR) required during the hypoglycaemic clamp study. This effect was mediated by blockade of insulin’s inhibitory effect on endogenous glucose production. Local blockade of B2ARs within the VMH using a specific antagonist partially diminished the effect of systemic activation of B2ARs during hypoglycaemia at least in part by diminishing the adrenaline (epinephrine) response to hypoglycaemia. Peripheral B2AR agonist injection also enhanced glucose recovery from insulin-induced hypoglycaemia.

Conclusions/interpretation

Systemic B2AR agonist administration acts to limit insulin-induced hypoglycaemia by offsetting insulin’s inhibitory effect on hepatic glucose production. This effect appears to be predominately mediated via a direct effect on liver B2ARs, but a small stimulatory effect on B2ARs within the VMH cannot be excluded. Our data suggest that formoterol may have therapeutic value to limit the risk of hypoglycaemia in patients with diabetes.
Literatur
1.
Zurück zum Zitat The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. TN Engl J Med 329:977–986CrossRef The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. TN Engl J Med 329:977–986CrossRef
2.
Zurück zum Zitat The Diabetes Control and Complications Trial Research Group (1997) Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes 46:271–286CrossRef The Diabetes Control and Complications Trial Research Group (1997) Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes 46:271–286CrossRef
3.
Zurück zum Zitat Sherwin RS, Shamoon H, Hendler R, Sacca L, Eigler N, Walesky M (1980) Epinephrine and the regulation of glucose metabolism: effect of diabetes and hormonal interactions. Metabolism 29:1146–1154CrossRefPubMed Sherwin RS, Shamoon H, Hendler R, Sacca L, Eigler N, Walesky M (1980) Epinephrine and the regulation of glucose metabolism: effect of diabetes and hormonal interactions. Metabolism 29:1146–1154CrossRefPubMed
4.
Zurück zum Zitat Rizza RA, Cryer PE, Gerich JE (1979) Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. J Clin Invest 64:62–71CrossRefPubMed Rizza RA, Cryer PE, Gerich JE (1979) Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. J Clin Invest 64:62–71CrossRefPubMed
5.
Zurück zum Zitat UK Hypoglycaemia Study Group (2007) Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 50:1140–1147CrossRef UK Hypoglycaemia Study Group (2007) Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 50:1140–1147CrossRef
6.
Zurück zum Zitat Amiel SA, Tamborlane WV, Simonson DC, Sherwin RS (1987) Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med 316:1376–1383CrossRefPubMed Amiel SA, Tamborlane WV, Simonson DC, Sherwin RS (1987) Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med 316:1376–1383CrossRefPubMed
7.
Zurück zum Zitat Jones TW, Porter P, Sherwin RS et al (1998) Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 338:1657–1662CrossRefPubMed Jones TW, Porter P, Sherwin RS et al (1998) Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 338:1657–1662CrossRefPubMed
8.
Zurück zum Zitat Cryer PE (2011) Elimination of hypoglycemia from the lives of people affected by diabetes. Diabetes 60:24–27CrossRefPubMed Cryer PE (2011) Elimination of hypoglycemia from the lives of people affected by diabetes. Diabetes 60:24–27CrossRefPubMed
9.
Zurück zum Zitat Donovan CM, Halter JB, Bergman RN (1991) Importance of hepatic glucoreceptors in sympathoadrenal response to hypoglycemia. Diabetes 40:155–158CrossRefPubMed Donovan CM, Halter JB, Bergman RN (1991) Importance of hepatic glucoreceptors in sympathoadrenal response to hypoglycemia. Diabetes 40:155–158CrossRefPubMed
10.
Zurück zum Zitat Borg MA, Sherwin RS, Borg WP, Tamborlane WV, Shulman GI (1997) Local ventromedial hypothalamus glucose perfusion blocks counterregulation during systemic hypoglycemia in awake rats. J Clin Invest 99:361–365CrossRefPubMed Borg MA, Sherwin RS, Borg WP, Tamborlane WV, Shulman GI (1997) Local ventromedial hypothalamus glucose perfusion blocks counterregulation during systemic hypoglycemia in awake rats. J Clin Invest 99:361–365CrossRefPubMed
11.
Zurück zum Zitat Beverly JL, de Vries MG, Bouman SD, Arseneau LM (2001) Noradrenergic and GABAergic systems in the medial hypothalamus are activated during hypoglycemia. Am J Physiol Regul Integr Comp Physiol 280:R563–R569PubMed Beverly JL, de Vries MG, Bouman SD, Arseneau LM (2001) Noradrenergic and GABAergic systems in the medial hypothalamus are activated during hypoglycemia. Am J Physiol Regul Integr Comp Physiol 280:R563–R569PubMed
12.
Zurück zum Zitat Szepietowska B, Zhu W, Chan O, Horblitt A, Dziura J, Sherwin RS (2011) Modulation of beta-adrenergic receptors in the ventromedial hypothalamus influences counterregulatory responses to hypoglycemia. Diabetes 60:3154–3158CrossRefPubMed Szepietowska B, Zhu W, Chan O, Horblitt A, Dziura J, Sherwin RS (2011) Modulation of beta-adrenergic receptors in the ventromedial hypothalamus influences counterregulatory responses to hypoglycemia. Diabetes 60:3154–3158CrossRefPubMed
13.
Zurück zum Zitat McCrimmon RJ, Shaw M, Fan X et al (2008) Key role for AMP-activated protein kinase in the ventromedial hypothalamus in regulating counterregulatory hormone responses to acute hypoglycemia. Diabetes 57:444–450CrossRefPubMed McCrimmon RJ, Shaw M, Fan X et al (2008) Key role for AMP-activated protein kinase in the ventromedial hypothalamus in regulating counterregulatory hormone responses to acute hypoglycemia. Diabetes 57:444–450CrossRefPubMed
14.
Zurück zum Zitat McCrimmon RJ, Fan X, Ding Y, Zhu W, Jacob RJ, Sherwin RS (2004) Potential role for AMP-activated protein kinase in hypoglycemia sensing in the ventromedial hypothalamus. Diabetes 53:1953–1958CrossRefPubMed McCrimmon RJ, Fan X, Ding Y, Zhu W, Jacob RJ, Sherwin RS (2004) Potential role for AMP-activated protein kinase in hypoglycemia sensing in the ventromedial hypothalamus. Diabetes 53:1953–1958CrossRefPubMed
15.
Zurück zum Zitat Wall JS, Steele R, de Bodo RC, Altszuler N (1957) Effect of insulin on utilization and production of circulating glucose. Am J Physiol 189:43–50PubMed Wall JS, Steele R, de Bodo RC, Altszuler N (1957) Effect of insulin on utilization and production of circulating glucose. Am J Physiol 189:43–50PubMed
16.
Zurück zum Zitat Steele R, Wall JS, de Bodo RC, Altszuler N (1956) Measurement of size and turnover rate of body glucose pool by the isotope dilution method. Am J Physiol 187:15–24PubMed Steele R, Wall JS, de Bodo RC, Altszuler N (1956) Measurement of size and turnover rate of body glucose pool by the isotope dilution method. Am J Physiol 187:15–24PubMed
17.
Zurück zum Zitat McCrimmon RJ, Song Z, Cheng H et al (2006) Corticotrophin-releasing factor receptors within the ventromedial hypothalamus regulate hypoglycemia-induced hormonal counterregulation. J Clin Invest 116:1723–1730CrossRefPubMed McCrimmon RJ, Song Z, Cheng H et al (2006) Corticotrophin-releasing factor receptors within the ventromedial hypothalamus regulate hypoglycemia-induced hormonal counterregulation. J Clin Invest 116:1723–1730CrossRefPubMed
18.
Zurück zum Zitat Chu CA, Sindelar DK, Neal DW, Allen EJ, Donahue EP, Cherrington AD (1998) Effect of a selective rise in sinusoidal norepinephrine on HGP is due to an increase in glycogenolysis. Am J Physiol 274:E162–E171PubMed Chu CA, Sindelar DK, Neal DW, Allen EJ, Donahue EP, Cherrington AD (1998) Effect of a selective rise in sinusoidal norepinephrine on HGP is due to an increase in glycogenolysis. Am J Physiol 274:E162–E171PubMed
19.
Zurück zum Zitat Sacca L, Vigorito C, Cicala M, Corso G, Sherwin RS (1983) Role of gluconeogenesis in epinephrine-stimulated hepatic glucose production in humans. Am J Physiol 245:E294–E302PubMed Sacca L, Vigorito C, Cicala M, Corso G, Sherwin RS (1983) Role of gluconeogenesis in epinephrine-stimulated hepatic glucose production in humans. Am J Physiol 245:E294–E302PubMed
20.
Zurück zum Zitat Hendler RG, Sherwin RS (1984) Epinephrine-stimulated glucose production is not diminished by starvation: evidence for an effect on gluconeogenesis. J Clin Endocrinol Metab 58:1014–1021CrossRefPubMed Hendler RG, Sherwin RS (1984) Epinephrine-stimulated glucose production is not diminished by starvation: evidence for an effect on gluconeogenesis. J Clin Endocrinol Metab 58:1014–1021CrossRefPubMed
21.
Zurück zum Zitat Erraji-Benchekroun L, Couton D, Postic C et al (2005) Overexpression of beta2-adrenergic receptors in mouse liver alters the expression of gluconeogenic and glycolytic enzymes. Am J Physiol Endocrinol Metab 288:E715–E722CrossRefPubMed Erraji-Benchekroun L, Couton D, Postic C et al (2005) Overexpression of beta2-adrenergic receptors in mouse liver alters the expression of gluconeogenic and glycolytic enzymes. Am J Physiol Endocrinol Metab 288:E715–E722CrossRefPubMed
22.
Zurück zum Zitat Frizzell RT, Hendrick GK, Brown LL et al (1988) Stimulation of glucose production through hormone secretion and other mechanisms during insulin-induced hypoglycemia. Diabetes 37:1531–1541CrossRefPubMed Frizzell RT, Hendrick GK, Brown LL et al (1988) Stimulation of glucose production through hormone secretion and other mechanisms during insulin-induced hypoglycemia. Diabetes 37:1531–1541CrossRefPubMed
23.
Zurück zum Zitat Connolly CC, Myers SR, Neal DW, Hastings JR, Cherrington AD (1996) In the absence of counterregulatory hormones, the increase in hepatic glucose production during insulin-induced hypoglycemia in the dog is initiated in the liver rather than the brain. Diabetes 45:1805–1813CrossRefPubMed Connolly CC, Myers SR, Neal DW, Hastings JR, Cherrington AD (1996) In the absence of counterregulatory hormones, the increase in hepatic glucose production during insulin-induced hypoglycemia in the dog is initiated in the liver rather than the brain. Diabetes 45:1805–1813CrossRefPubMed
24.
Zurück zum Zitat Liu D, McManus RM, Ryan EA (1996) Improved counter-regulatory hormonal and symptomatic responses to hypoglycemia in patients with insulin-dependent diabetes mellitus after 3 months of less strict glycemic control. Clin Invest Med 19:71–82PubMed Liu D, McManus RM, Ryan EA (1996) Improved counter-regulatory hormonal and symptomatic responses to hypoglycemia in patients with insulin-dependent diabetes mellitus after 3 months of less strict glycemic control. Clin Invest Med 19:71–82PubMed
25.
Zurück zum Zitat Cranston I, Lomas J, Maran A, Macdonald I, Amiel SA (1994) Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Lancet 344:283–287CrossRefPubMed Cranston I, Lomas J, Maran A, Macdonald I, Amiel SA (1994) Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Lancet 344:283–287CrossRefPubMed
26.
Zurück zum Zitat Dagogo-Jack S, Rattarasarn C, Cryer PE (1994) Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes 43:1426–1434CrossRefPubMed Dagogo-Jack S, Rattarasarn C, Cryer PE (1994) Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes 43:1426–1434CrossRefPubMed
27.
Zurück zum Zitat Fanelli C, Pampanelli S, Epifano L et al (1994) Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Diabetologia 37:1265–1276CrossRefPubMed Fanelli C, Pampanelli S, Epifano L et al (1994) Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Diabetologia 37:1265–1276CrossRefPubMed
28.
Zurück zum Zitat Bartow RA, Brogden RN (1998) Formoterol. An update of its pharmacological properties and therapeutic efficacy in the management of asthma. Drugs 55:303–322CrossRefPubMed Bartow RA, Brogden RN (1998) Formoterol. An update of its pharmacological properties and therapeutic efficacy in the management of asthma. Drugs 55:303–322CrossRefPubMed
29.
Zurück zum Zitat Cooperberg BA, Breckenridge SM, Arbelaez AM, Cryer PE (2008) Terbutaline and the prevention of nocturnal hypoglycemia in type 1 diabetes. Diabetes Care 31:2271–2272CrossRefPubMed Cooperberg BA, Breckenridge SM, Arbelaez AM, Cryer PE (2008) Terbutaline and the prevention of nocturnal hypoglycemia in type 1 diabetes. Diabetes Care 31:2271–2272CrossRefPubMed
30.
Zurück zum Zitat Saleh TY, Cryer PE (1997) Alanine and terbutaline in the prevention of nocturnal hypoglycemia in IDDM. Diabetes Care 20:1231–1236CrossRefPubMed Saleh TY, Cryer PE (1997) Alanine and terbutaline in the prevention of nocturnal hypoglycemia in IDDM. Diabetes Care 20:1231–1236CrossRefPubMed
Metadaten
Titel
β2-Adrenergic receptor agonist administration promotes counter-regulatory responses and recovery from hypoglycaemia in rats
verfasst von
Barbara Szepietowska
Wanling Zhu
Robert S. Sherwin
Publikationsdatum
01.11.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Diabetologia / Ausgabe 11/2013
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-013-3009-7

Weitere Artikel der Ausgabe 11/2013

Diabetologia 11/2013 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.