Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Endocr Rev. 2019 Jun 1;40(3):768-788. doi: 10.1210/er.2018-00226.
Glucose homeostasis requires an organism to rapidly respond to changes in plasma glucose concentrations. Iatrogenic hypoglycemia as a result of treatment with insulin or sulfonylureas is the most common cause of hypoglycemia in humans and is generally only seen in patients with diabetes who take these medications. The first response to a fall in glucose is the detection of impending hypoglycemia by hypoglycemia-detecting sensors, including glucose-sensing neurons in the hypothalamus and other regions. This detection is then linked to a series of neural and hormonal responses that serve to prevent the fall in blood glucose and restore euglycemia. In this review, we discuss the current state of knowledge about central glucose sensing and how detection of a fall in glucose leads to the stimulation of counterregulatory hormone and behavior responses. We also review how diabetes and recurrent hypoglycemia impact glucose sensing and counterregulation, leading to development of impaired awareness of hypoglycemia in diabetes.
葡萄糖稳态需要机体快速响应血浆葡萄糖浓度的变化。由于胰岛素或磺酰脲类药物治疗而导致的医源性低血糖是人类低血糖最常见的原因，且通常仅见于服用这些药物的糖尿病患者。对葡萄糖下降的最初响应是由低血糖检测传感器检测到即将发生的低血糖，包括在下丘脑和其他区域的葡萄糖敏感神经元。这种检测随后与一系列神经和激素反应相关联，这些反应有助于防止血糖下降并恢复正常血糖水平。在这篇综述中，我们讨论了关于中枢葡萄糖感测的现有知识状态，以及葡萄糖下降的检测如何导致促激素和行为反应的刺激。我们还回顾了糖尿病和反复低血糖如何影响葡萄糖感测和代偿，导致糖尿病患者出现低血糖意识受损。
