Metabolic control and auditory information processing at altered glucose levels in insulin-dependent diabetes

Previous work with a visual reaction time (RT) paradigm showed rate of mental processing to be slowed during a state of brain energy depletion (i.e., hypoglycemia). The present study employed an analog auditory RT paradigm to determine if modality differences in processing information might occur in response to glucose alteration. A balanced crossover design was used in which men with insulin-dependent diabetes completed RT tasks of increasing complexity at each of the following glucose levels: hypoglycemia (60 mg/dL), normoglycemia/control (110 mg/dL), and hyperglycemia (300 mg/dL). Results revealed two performance groups. A convergent group displayed slower RT responding during hypoglycemia, consistent with the visual RT pattern of results. A divergent group displayed better responding on one RT measure during hypoglycemia, and generally poorer responding on all RT measures during the other glucose conditions. Subjects in the divergent group maintained more stringent metabolic control and tended to have experienced more episodes of hypoglycemic unconsciousness. The present results provide the first evidence that more stringent metabolic control may be related to generally slower rates of processing auditory information. Possible explanations for these findings include hypotheses of immutable structual derangement, state-dependent performance effects, and a U-shaped response curve.