Glucoregulation in Patients with Autonomic Neuropathy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 758-775-Beta Cells, Glucose Control & Complications
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-764
Shalini Paturi*1, Mohita Kumar2, Janice L Gilden3, Boby George Theckedath4 and Janine Stoll5
1Rosalind Franklin University of Medicine and Science/Chicago Medical School, Green Oaks, IL, 2Capt. James A. Lovell FHCC, North Chicago, IL, 3RFUMS/Chicago Med Schl, Chicago, IL, 4Capt. James A Lovell FHCC, North Chicago, IL, 5Capt James A Lovell FHCC, North Chicago, IL
Background: It has been suggested that increased episodes of hypoglycemia (HYPO)  in diabetic patients may be responsible for further autonomic failure (AN) as well as sudden death.  Patients with AN also have a higher incidence of sudden death, but the reasons for this are unclear. Since glucoregulation in AN is not well characterized, we evaluated whether HYPO  is more common in non-diabetic patients with AN.

Methods: A retrospective chart review of 100 patients,  who had  unbiased glucose measurements by 72hr continuous glucose monitoring system (CGMS),  identified 20 non-diabetic patients with AN who had symptoms suggestive of  HYPO (postprandial dizziness, lightheadedness, nervousness, hunger relieved by food)  [(17 with Neurogenic Orthostatic Hypotension: 2 post gastric bypass surgery)( 10 female: 10  male) (mean age= 54.8; range=22-76 yrs ) (Bezett QTc interval = 423-482mm; resting HR=77±4)]. Glucose values from CGMS were then mathematically transformed into % time above normal (%AN)  (>140 mg%), % normal (%N) (70-140 mg%), and % below normal (%BN) (<70 mg%) for 3 time intervals: (T1=0600-1800hrs); (T2=1800-2400hrs); (T3=2400-0600hrs). Glucose averages for the 72 hr time period were also calculated.

Results:   CGMS showed that 85% AN patients with symptoms had HYPO at least once during the 72 hrs of monitoring, more often at T1 (70%) than T2 (55%), T3(55%) and for all 3 time intervals  combined.  Glucose values %BN were 3.9 ±0.8, but  %AN =16 ± 6.7  and %N =80 ± 6.9%. Patients with QTc < 440 mm had higher % BN for T1 (6.4±2.3 vs 2.5± 0.2; p<.05) and for overall %N (92.2 ± 1.6 vs 59.7 ±17.4; p<.001), but less overall  %  AN (3.2 ± 0.9 vs 37.0 ± 17.9; p<.001).  Less AN, as measured by lower QTc interval, correlated with greater % of normal sugars  (r2=-0.52; p<.05) and a lower resting HR (r2= 0.72; p=.002). 

Conclusions: Patients with AN experience HYPO more often during the daytime with patterns suggestive of reactive hypoglycemia.  Further, glucoregulation may depend upon the integrity of the autonomic nervous system, since patients with QTC<440 mm were more likely to be vulnerable to hypoglycemia. Therefore, it is important to evaluate all AN patients with nonspecific symptoms for hypoglycemia.

Nothing to Disclose: SP, MK, JLG, BGT, JS

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: Acknowledgements: Research sponsored by JAL FHCC