The role of adrenaline in diabetes
Adrenaline is a hormone made by the adrenal glands in the form of epinephrine. It is mainly released when we feel threatened, stressed or nervous. Adrenaline causes numerous changes in the body that make it more willing to perform: It increases blood pressure, heart rate and heart rate, improves the transmission of impulses in the heart muscle cells, widens the airways, increases respiratory rate and causes more blood to flow to the brain , the musculature and the heart, instead of the skin, stomach and kidneys (Goldstein 1999; Westfall and Westfall 2011).
Simply put, adrenaline is designed to release energy reserves in the form of glucose and free fatty acids in anticipation of physical activity or recovery from hypoglycemia. In order to recover from hypoglycemia, endogenous insulin secretion must be suppressed and glucagon secretion from the alpha cells of the pancreas and adrenaline secretion must be stimulated (Verberne et al. 2016).
In addition, adrenaline increases plasma glucose by inducing glycogenolysis in the liver and muscles, as well as gluconeogenesis in the liver and also by inhibiting glucose uptake by the muscles.
diabetes and adrenaline
Especially for diabetics, especially type I, adrenaline is very important as an opponent of insulin and thus for counter-regulation in hypoglycemia, because type I diabetics can release neither insulin nor glucagon into the blood. Within five years of being diagnosed with type I diabetes, the body loses the automatic response to release glucagon in hypoglycemia. It has not yet been clearly clarified why this mechanism occurs (Amiel 2005; McCrimmon 2009).
In 2000, Sanders and Ritter found in a study that insulin-induced hypoglycaemia leads to increased levels of glucagon and adrenaline in the plasma, but to persistently low blood glucose levels. As described above, the automatic release of glucagon no longer works in the case of hypoglycaemia in insulin-dependent diabetics. However, other glucagon-stimulating substances such as arginine or carbachol continue to function (Fukuda et al. 1988). In an experiment with rats, it was also observed that 12 weeks after the onset of type I diabetes, electrical stimulation of certain brain regions could not provoke sufficient glucagon release, while the response to arginine was normal (Hertelendy et al. 1992).
The results suggest that there is an "encapsulation" between brain regions that sense extracellular glucose levels and the autonomic output of the pancreas. However, numerous questions remain unanswered.
Where is the hypoglycemia registered?
Why are there so many different areas in the body that sense glucose?
Regarding 2., it is assumed that this is so because the glucose balance is not only crucial for bodily functions, but also for the functioning of the nervous system.
What happens with moderate loads?
During moderate physical activity, plasma concentration of adrenaline increases, while secretion increases only slightly. It is therefore assumed that with moderate training, less adrenaline is broken down instead of being released. However, when adrenaline is infused, plasma renin, glucose, and free fatty acids increase. However, the cardiovascular system is hardly affected.
In conclusion, adrenaline is a metabolic hormone that is extremely important in triggering a counter-response to hypoglycemia. Therefore, since the article by Verberne et al. (2016) as a “primary antagonist hormone in type I diabetics”. And finally it becomes clear: adrenaline is not only bad and increases blood sugar. It can also be life saving.
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