Glycemic response to stress is altered in euglycemic Pima Indians
The aim of this work was to study the effects of a computer-driven mental arithmetic task on blood glucose in a group of four male and four female euglycemic Caucasians and a group of seven male and six female euglycemic Pima Indians. Approximately 60% of euglycemic Pima Indian Native Americans eventually develop type 2 diabetes, while only 5% of Caucasians develop the disease. All subjects had normal glucose tolerance. Subjects were given a standard breakfast; 2 h later, they were given a computerized mental arithmetic stress test for 10 min. Before, during and after the test, several variables were analyzed, including serum concentrations of glucose, insulin, glucagon and plasma cortisol and catecholamines. Heart rate, systolic and diastolic blood pressure and all the stress hormones increased during stress and decreased during recovery in all subjects. Blood glucose consistently declined one hour after the meal in all subjects. However, while it continued to decline following stress in seven out of eight Caucasian subjects, it consistently increased during and following stress in 10 out of 13 Pima Indians. Fasting serum glucose in Pima Indians and Caucasians was respectively 5.07 ?? 0.08 mM and 5.04 ?? 0.09 mM. Two-hour post-prandial values were 5.63 ?? 0.22 mM and 5.48 ?? 0.19 mM respectively, whereas post-stress values were 6.15 ?? 0.19 mM for Pima Indians and 5.22 ?? 0.20 mM for Caucasians. Both serum glucose means following stress (t = 3.1, P lt; 0.005) and the direction of change in serum glucose in response to mental arithmetic (??2 = 8.2, P lt; 0.01) clearly differentiated Pimas from Caucasians. These data suggest that abnormal glycemic responsiveness to stress, even in the absence of impaired glucose tolerance, may be present in subjects at high risk of developing diabetes and may therefore be related in some way to the chain of events leading to the development of the disease.