SummaryTo assess the relative roles of insulin and hypoglycaemia on induction of neuroendocrine responses, symptoms and deterioration of cognitive function (12 cognitive tests) during progressive decreases in plasma glucose, and to quantitate glycaemic thresholds, 22 normal, non-diabetic subjects (11 males, 11 females) were studied on four occasions: prolonged fast (n = 8, saline euglycaemia study, SA-EU), stepped hypogtycaemia (plasma glucose plateaus of 4.3, 3.7, 3 and 2.3 mmol/1) or euglycaemia during insulin infusion at 1 and 2 mU. kg -1. min -1 (n = 22, high-insulin hypoglycaemia and euglycaemia studies, HI-INS-HYPO and HI-INS-EU, respectively), and stepped hypoglycaemia during infusion of insulin at 0.35 mU. kgl.min -a (n = 9, low-insulin hypoglycaemia study, LO-INS-HYPO). Insulin per se (SA-EU vs HI-INS-EU), suppressed plasma glucagon (-20 %) and pancreatic polypeptide (-30 %), whereas it increased plasma noradrenaline (-10 %, p < 0.05). Hypoglycaemia per se (HI-INS-HYPO vs HI-INS-EU) induced responses of counterregulatory hormones (CR-HORM), symptoms and deteriorated cognitive function. With the exception of suppression of endogenous insulin secretion, which had the lowest glycaemic threshold of 4.44 + 0.06 mmol/1, pancreatic polypeptide, glucagon, growth hormone, adrenaline and cortisol had similar glycaemic thresholds (-3.8-3.6 mmol/1); noradrenaline (3.1 + 0.0 mmol/1), autonomic (3.05 + 0.06 retool/l) and neuroglycopenic (3.05 + 0.05 mmol/1) symptoms had higher thresholds. All 12 tests of cognitive function deteriorated at a glycaemic threshold of 2.45 + 0.06 mmol/1, but 7 out of 12 tests were already abnormal at a glycaemic threshold of 2.89 + 0.06 mmol/1. Although all CR-HORM had a similar glycaemic threshold, the lag time of response (the time required for a given parameter to increase) of glucagon (15+1min) and growth hormone (14 + 3 min) was shorter than adrenaline (19 + 3 min) and cortisol (39 + 4 min) (p < 0.05). With the exception of glucagon (which was suppressed) and noradrenaline (which was stimulated), insulin per se (HI-INS-HYPO vs LO-INS-HYPO) did not affect the responses of CR-HORM, and did not influence the symptoms or the cognitve function during hypoglycaemia. Despite lower responses of glucagon, adrenaline and growth hormone (but not thresholds) in females than males, females were less insulin sensitive than males during stepped hypoglycaemia. [Diabetologia (1994) It is well established that normal humans respond to an acute decrease in plasma glucose concentration, first, by suppressing endogenous insulin secretion, and, second, by increasing counterregulatory hormones. These responses occur following a plasma glucose decrement of only -1 mmol/1 below the values of the post-absorptive state. The third response is the appearance of hypoglycaemic symptoms, which only occur if the plasma
