Hypoglycaemia increases aldosterone in a dose-dependent fashion

Abstract

Aims: Intensive glycaemic control increases the incidence of hypoglycaemia. We sought to define the effects of hypoglycaemia on aldosterone, a hormone involved in cardiovascular injury and baroreflex impairment.

Methods: To contrast the effects of hypoglycaemia and euglycaemia on aldosterone and plasma renin activity, in Study 1, we assessed hormone levels in 13 subjects who participated in euglycaemic (5.0 mmol/l) and hypoglycaemic (2.8 mmol/l) hyperinsulinaemic clamp protocols in random order. To determine the relationship between aldosterone and the depth of hypoglycaemia, in Study 2, we assessed hormone levels in an additional 13 subjects who participated in a 3-h stepped hypoglycaemic hyperinsulinaemic clamp protocol; blood glucose was reduced in 0.55 mmol/l steps from 5.0 to 2.2 mmol/l. Subjects were healthy and consumed controlled sodium diets.

Results: In Study 1, aldosterone increased approximately 2.5-fold during hypoglycaemic hyperinsulinaemia, P<0.001, but did not rise with euglycaemic hyperinsulinaemia. Plasma renin activity increased during both hyperinsulinaemic clamps; however, the increase was greater during hypoglycaemia (Δ=1.5 ± 0.2 ng ml(-1) h(-1) ) vs. euglycaemia (Δ=0.5 ± 0.1 ng ml(-1) h(-1) ), P<0.005. In Study 2, aldosterone increased significantly at glucose levels of 2.8 mmol/l; this increase was amplified with glucose of 2.2 mmol/l. Aldosterone increases paralleled those of ACTH.

Conclusions: Hypoglycaemia increases aldosterone in a dose-dependent fashion. This increase is likely attributable to activation of the renin-angiotensin-aldosterone system and increases in ACTH. Because aldosterone activation of the mineralocorticoid receptor is implicated in the pathophysiology of cardiovascular injury, including vascular dysfunction, inflammation, baroreflex impairment and cardiac arrhythmias, these findings may be of relevance in individuals who experience hypoglycaemia.

Conflict of interest statement

Competing interests Nothing to declare.

© 2010 The Authors. Diabetic Medicine © 2010 Diabetes UK.

Figures

Figure 1

(a) Serum glucose levels during euglycaemic hyperinsulinaemic clamp studies (closed squares) and during hypoglycaemic hyperinsulinaemic clamp studies (open circles). Arrow indicates target glucose of 5.0 mmol/l for the euglycaemia protocol and 2.8 mmol/l for the hypoglycaemia protocol. (b) Plasma renin activity (PRA) levels at baseline (T = 0 min) and end (T = 135 min) of the euglycaemic (black bars) and hypoglycaemic (open bars) hyperinsulinaemic clamp studies. *P < 0.05 vs. baseline euglycaemia; †P < 0.001 vs. all other groups; n = 8 per group. (c) Aldosterone (n = 12) and epinephrine (n = 5) levels during the hypoglycaemic hyperinsulinaemic clamp (open circles) and euglycaemic hyperinsulinaemic clamp (black squares), P < 0.001 for aldosterone and P < 0.0001 for epinephrine by repeated measures ANOVA.

Figure 2

(A) Serum glucose, (B) aldosterone and (C) ACTH levels during the 180-min stepped, hypoglycaemic, hyperinsulinaemic clamp study, n = 13; P < 0.001 for each hormone by repeated measures ANOVA. ACTH values were reported previously (17). Upper panel in (a) indicates target blood glucose levels.