Hypoglycemia reduces sympathoadrenal responses to subsequent hypoglycemic bouts by an unknown mechanism. To assess whether such hypoglycemia-associated autonomic failure is due to actual brain damage, male Sprague-Dawley rats underwent 1-h bouts of insulininduced (5 U/kg i.v.) hypoglycemia (1.6-2.8 mmol/l) 1 or 3 times on alternate days. Rats remained alert and were rescued with intravenous glucose at 60-80 min. Plasma epinephrine and corticosterone responses were significantly reduced during the second and third bouts. Brains from these rats were processed by the terminal transferase-mediated deoxyuridine triphosphatebiotin nick end-labeling ( W ith the advent of intensive insulin therapy for type 1 diabetes, there has been an increasing incidence of hypoglycemic episodes (1). Some of these are severe, resulting in coma and subsequent permanent brain damage and/or death (2-5). Other less severe hypoglycemic episodes do not impair consciousness. Regardless of degree, hypoglycemia is associated with a robust counterregulatory response (CRR) (6-9). Low levels of plasma glucose are sensed by selective neurons in the brain (10-14) as well as by glucosensors in the hepatic portal vein (15). Signals from these sensors provoke activation of the sympathoadrenal system with preferential release of epinephrine. In addition, cortisol is released from the adrenal cortex and glucagon from the pancreatic ␣-cells (6-9,16). This response maximizes the mobilization of glucose in the body. In addition to this CRR, subjects develop an awareness of their hypoglycemic state (6,9). Both the CRR and the hypoglycemia awareness can become blunted after only a single bout of hypoglycemia (9,17). Hypoglycemia awareness recovers fairly rapidly but the diminished CRR is often prolonged (6), suggesting that different mechanisms are responsible for the two phenomena. However, the mechanism underlying either of these remains unclear.Here, we present a rat model of the dampened CRR and show that a single bout of moderate hypoglycemia produces highly site-specific apparent apoptotic response in cells of the hypothalamic arcuate nucleus (ARC). This apoptosis is associated with a significant reduction in the expression of both neuropeptide Y (NPY) and pro-opiomelanocortin (POMC) mRNA in this same nucleus.
RESEARCH DESIGN AND METHODSAnimals and hypoglycemia. Male Sprague-Dawley rats were used at 300-400 g. They were housed at 22-23°C on a 12-h light-dark schedule and fed Purina rat chow (#5001) (PMI Nutrition International, Brentwood, MO) ad libitum. One group of rats (n = 12) had right atrial silastic catheters implanted via the right jugular vein under ketamine (45 mg/kg)/xylazine (9 mg/kg i.p.) anesthesia with buprenorphine (0.2 mg/kg) analgesia. Catheters were filled with a polyvinylpyrrolidone/heparin mix, which was replaced daily. The rats were allowed 4-5 days to recover and then were fasted overnight. Additional rats without venous catheters were also used (n = 34) and fasted overnight before testing. Between 0800 and 1000, a blood sample (...