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Effect of antecedent glucose control on cerebral function during hypoglycemia
S A Amiel1, R C Pottinger, H R Archibald
1Department of Diabetes and Immunogenetics, Medical College of St. Bartholomew's Hospital, London, England, United Kingdom.
Diabetes Care
|February 1, 1991
Summary
Intensively treated diabetes patients show reduced hormonal responses to low blood glucose (hypoglycemia) but increased brainwave (EEG) abnormalities. This adaptation increases their risk of severe hypoglycemia.
Area of Science:
- Endocrinology
- Neuroscience
- Metabolic Disorders
Background:
- Intensive treatment of diabetes mellitus aims to maintain optimal glycemic control.
- However, intensive glycemic control is associated with a threefold increase in both severe and asymptomatic hypoglycemia.
- The underlying mechanisms, particularly cerebral adaptation to recurrent hypoglycemia, require further investigation.
Purpose of the Study:
- To investigate the effect of prior glycemic experience on hormonal, electroencephalogram (EEG), and evoked potential responses during experimentally induced hypoglycemia.
- To determine if cerebral adaptation to low blood glucose levels contributes to the increased incidence of hypoglycemia in intensively treated diabetic patients.
Main Methods:
- A slow-fall clamp technique was used to induce controlled hypoglycemia.
- Three groups were studied: well-controlled diabetic patients/insulinoma patients (group 1), poorly controlled diabetic patients (group 2), and non-diabetic subjects (group 3).
- Hormonal (epinephrine), EEG, and symptom perception thresholds were assessed during induced hypoglycemia.
Main Results:
- Group 1 exhibited a significantly lower glucose threshold for epinephrine release and reduced peak epinephrine response compared to groups 2 and 3.
- Symptom perception was delayed until lower blood glucose levels were reached in group 1.
- EEG abnormalities indicative of hypoglycemia occurred in all group 1 subjects at higher glucose levels than in other groups, despite similar nadir blood glucose levels.
Conclusions:
- The glycemic threshold for counterregulatory hormonal responses is lowered in individuals with intensively treated diabetes or insulinomas.
- These individuals demonstrate a greater susceptibility to developing EEG abnormalities during hypoglycemia.
- This dissociation between hormonal response and cerebral adaptation explains the heightened vulnerability to severe hypoglycemia in intensively treated diabetic patients.