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Metabolism. 2009 Jun;58(6):812-20. doi: 10.1016/j.metabol.2009.01.019.

Brain insulin infusion does not augment the counterregulatory response to hypoglycemia or glucoprivation.

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Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University, St Louis, MO 63110, USA.


Although high dosages of insulin can cause hypoglycemia, several studies suggest that increased insulin action in the head may paradoxically protect against severe hypoglycemia by augmenting the sympathoadrenal response to hypoglycemia. We hypothesized that a direct infusion of insulin into the third ventricle and/or the mediobasal hypothalamus (MBH) would amplify the sympathoadrenal response to hypoglycemia. Nine-week-old male rats had insulin (15 mU) or artificial cerebrospinal fluid (aCSF, control) infused bilaterally into the MBH or directly into the third ventricle. During the final 2 hours of the brain insulin or aCSF infusions, the counterregulatory response to either a hyperinsulinemic hypoglycemic (approximately 50 mg/dL) clamp or a 600-mg/kg intravenous bolus of 2-deoxyglucose (2DG) was measured. 2-Deoxyglucose was used to induce a glucoprivic response without peripheral insulin infusion. In response to insulin-induced hypoglycemia, epinephrine rose more than 60-fold, norepinephrine rose more than 4-fold, glucagon rose 8-fold, and corticosterone rose almost 2-fold; but these increments were not different in aCSF vs insulin treatment groups with either intracerebroventricular or bilateral MBH insulin protocols. Intracerebroventricular insulin infusion stimulated insulin signaling as noted by a 5-fold increase in AKT phosphorylation. In the absence of systemic insulin infusion, 2DG-induced glucopenia resulted in an equal counterregulatory response with brain aCSF and insulin infusions. Under the conditions studied, although insulin infusion acted to stimulate hypothalamic insulin signaling, neither intrahypothalamic nor intracerebroventricular insulin infusion augmented the counterregulatory response to hypoglycemia or to 2DG-induced glucoprivation. Therefore, it is proposed that the previously noted acute actions of insulin to augment the sympathoadrenal response to hypoglycemia are likely mediated via mechanisms exterior to the central nervous system.

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