Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Effects of Antecedent Hypoglycaemia on the Gastric and Cardiac Responses to Subsequent Hypoglycaemia in Health (#81)

Palash Kar 1 2 , Mark P Plummer 1 2 , Yasmine Ali Abdelhamid 1 2 , Emma J Giersch 1 , Matthew J Summers 1 , Seva Hatzinikolas 3 , Simon Heller 4 , Marianne J Chapman 1 2 3 , Michael Horowitz 3 5 , Karen Jones 3 5 , Adam Deane 1 2 3
  1. Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
  3. NHMRC Centre for Research Excellence, University of Adelaide, Adelaide, South Australia, Australia
  4. Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom
  5. Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia


In both health and patients with diabetes, acute hypoglycaemia triggers counter-regulatory responses accelerating gastric emptying and increasing cardiac contractility. However, antecedent hypoglycaemia attenuates endogenous catecholamine and vagal responses to subsequent hypoglycaemia (1). Our objective was to determine the effect of antecedent hypoglycaemia on gastric and cardiac responses to subsequent hypoglycaemia in health.



Ten healthy males were studied on two occasions, each lasting 30 hours, separated by ≥ 6 weeks and randomised to either:

  • ‘Control’ (Day 1 (C1) - three blood glucose clamps at 6 mmol/L followed by day 2 (C2) - one hypoglycaemic clamp at 2.8 mmol/L), or
  • ‘Antecedent hypoglycaemia’ (Day 1 (AH1) - three clamps at a blood glucose of 2.8 mmol/L followed by day 2 (AH2) - one clamp at 2.8 mmol/L).

Gastric emptying (GE) was measured on day 1 and 2, for both control (GEC1, GEC2) and antecedent hypoglycaemia (GEAH1, GEAH2) periods, using scintigraphy. Cardiac contractility was measured using fractional shortening (FS) via 2D echocardiography on days 1 and 2 of the control (FSC1, FSC2) and antecedent hypoglycaemia (FSAH1, FSAH2) periods. Data are mean (SE).



Gastric emptying was faster (GEC2 AUC vs. GEC1 AUC, P=0.01) and fractional shortening greater (FSC2 vs. FSC1, P<0.01) during acute (single episode) hypoglycaemia compared to euglycaemia. Following antecedent hypoglycaemia, gastric emptying was unaffected (GEAH2AUC vs. GEC2 AUC, P=0.74, Figure 1) however fractional shortening may be reduced (FSAH2 vs. FSC2, P=0.06), although this was not statistically significant.



In health, the acceleration of gastric emptying during acute hypoglycaemia does not appear to be affected by antecedent hypoglycaemia whereas the increase in cardiac contractility may be attenuated.



  1. 1. Heller SR, Cryer PE. Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia after 1 episode of hypoglycemia in nondiabetic humans. Diabetes. 1991 Feb;40(2):223-6. PubMed PMID: 1991573.