Kang L, Sanders NM, Dunn-Meynell AA, Gaspers LD, Routh VH, Thomas AP, Levin BE. Prior hypoglycemia enhances glucose responsiveness in some ventromedial hypothalamic glucosensing neurons. Am J Physiol Regul Integr Comp Physiol 294: R784-R792, 2008. First published December 19, 2007 doi:10.1152/ajpregu.00645.2007.-Antecedent insulin-induced hypoglycemia (IIH) reduces adrenomedullary responses (AMR) to subsequent bouts of hypoglycemia. The ventromedial hypothalamus [VMH: arcuate (ARC) ϩ ventromedial nuclei] contains glucosensing neurons, which are thought to be mediators of these AMR. Since type 1 diabetes mellitus often begins in childhood, we used juvenile (4-to 5-wk-old) rats to demonstrate that a single bout of IIH (5 U/kg sc) reduced plasma glucose by 24% and peak epinephrine by 59% 1 day later. This dampened AMR was associated with 46% higher mRNA for VMH glucokinase, a key mediator of neuronal glucosensing. Compared with neurons from saline-injected rats, ventromedial nucleus glucose-excited neurons from insulin-injected rats demonstrated a leftward shift in their glucose responsiveness (EC50 ϭ 0.45 and 0.10 mmol/l for saline and insulin, respectively, P ϭ 0.05) and a 31% higher maximal activation by glucose (P ϭ 0.05), although this maximum occurred at a higher glucose concentration (saline, 0.7 vs. insulin, 1.5 mmol/l). Although EC50 values did not differ, ARC glucose-excited neurons had 19% higher maximal activation, which occurred at a lower glucose concentration in insulin-than salineinjected rats (saline, 2.5 vs. insulin, 1.5 mmol/l). In addition, ARC glucose-inhibited neurons from insulin-injected rats were maximally inhibited at a fivefold lower glucose concentration (saline, 2.5 vs. insulin, 0.5 mmol/l), although this inhibition declined at Ͼ0.5 mmol/l glucose. These data suggest that the increased VMH glucokinase after IIH may contribute to the increased responsiveness of VMH glucosensing neurons to glucose and the associated blunting of the AMR. glucokinase; counterregulatory response; hypoglycemia-associated autonomic failure; calcium imaging; arcuate nucleus; ventromedial nucleus; ventromedial hypothalamus RECURRENT BOUTS of insulin-induced hypoglycemia (IIH) are common in patients with type 1 diabetes mellitus, especially children (3,4,23,43). Such recurrent bouts lead to severe dampening of the hormonal counterregulatory and adrenomedullary responses (AMR) to subsequent bouts of hypoglycemia, a component of the clinical syndrome known as hypoglycemiaassociated autonomic failure (2, 13, 53). In nondiabetic adult rats, we showed that a single bout of hypoglycemia results in impairment of AMR, in association with upregulation of glucokinase (GK) mRNA expression in the ventromedial hypothalamus (VMH) (15, 53). This hypothalamic area, which includes the arcuate (ARC) and ventromedial nuclei (VMN), contains glucosensing neurons, which we postulate to be critical elements in the detection of and response to hypoglycemia (8,22,25,38,48,60). In contrast to most neurons in the brain, which utilize glu...