Glucagon response to hypoglycemia in diabetic neuropathy.

Glucagon release during insulin hypoglycemia was studied in diabetics with autonomic neuropathy (N = 9), diabetics without clinical neuropathy (N =8), and normals (N = 9). With similar hypoglycemic stimulus, growth hormone and plasma cortisol increased in all groups. Plasma glucagon increased threefold in normals (121 +/- 19 vs. 308 +/- 30 pg/ml., mean +/- SEM of baseline vs. hypoglycemic peak) and twofold in nonneuropathic diabetics (128 +/- 13 vs. 209 +/- 30). There was no glucagon rise during hypoglycemia in the neuropathic diabetics (128 +/- 23 vs. 115 +/- 20). Arginine infusion produced glucagon rise in the neuropathic diabetics (106 +/- 16 vs. 523 +/- 103). The study suggests that failure to release glucagon during hypoglycemia is due to diabetic neuropathy. Neuropathy may contribute to metabolic instability.