Lack of glucagon response to hypoglycemia in type I diabetics after long-term optimal therapy with a continuous subcutaneous insulin infusion pump

Counterregulatory hormonal responses were studied in six patients after 4–18 mo treatment with a continuous subcutaneous insulin infusion pump. In response to insulin-induced hypoglycemia, significant increases in epinephrine, norepinephrine, cortisol, and growth hormone were measured in all subjects, while in five of the six patients glucagon levels did not increase at all. The persistence of these abnormal glucagon responses despite long-term optimal glucose controlsuggests that they are not due to hyperglycemia perse, but are due rather to a specific alpha cell abnormality. The high incidence of asymptomatic hypoglycemia in these patients emphasizes that caution is necessary to avoid serious hypoglycemia when striving for near-normal glucose control with insulin infusion pump therapy.