Stress, hypoglycemia, and the autonomic nervous system

Author: Andrea Haas1, David Borsook2, Gail Adler1, Roy Freeman3
1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
2 Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
3 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address:
Conference/Journal: Auton Neurosci
Date published: 2022 Apr 4
Other: Volume ID: 240 , Pages: 102983 , Special Notes: doi: 10.1016/j.autneu.2022.102983. , Word Count: 167

Stress can be classified as either psychosocial or physiologic. Physiologic stress refers to stresses due to acute illness, trauma, pain, hypoglycemia, and sleep deprivation-much less is known regarding its health consequences. This review focuses on hypoglycemia as a model to further investigate physiological stress. Experimental mild to moderate hypoglycemia is a paradigmatic physiological stress that evokes autonomic, neuroendocrine, and immune responses. Hypoglycemic stress is an ideal model to examine the interactions and consequences of physiological stress on the autonomic nervous system. Acute hypoglycemia has been demonstrated to increase inflammatory markers, prolong QTc, and impair cardiac-vagal baroreflex sensitivity. Some of these consequences may not reverse completely when euglycemia is restored. For example, there is attenuation of the cardiac-vagal baroreflex, attenuation of the vascular sympathetic baroreflex (muscle sympathetic nerve activity response to transient hypotension), and attenuation of the catecholamine response to lower body negative pressure that is present the next day after hypoglycemia has resolved.

Keywords: Autonomic nervous system; Baroreflex; Hypoglycemia; Stress; Sympathetic nervous system.

PMID: 35417827 DOI: 10.1016/j.autneu.2022.102983