[Mental function, functional hierarchy of the brain and glucoregulation]

Mental function in insulin-dependent diabetic (IDD) patients can be correlated with the endocrine and metabolic symptoms and signs of anxiety. In IDD patients, anxiety is usually accompanied by hyperactivity of the hyperglycemic hypothalamo-visceral axis. The hypothalamus is controlled by different superior nervous structures (limbic system and cortex) which, themselves, receive dopaminergic afferences. Two main patterns of reaction to anxiety associated with two distinct patterns of hypothalamo-visceral reactions, are suggested. In one, excessive hypothalamo-visceral reactions to stress can be associated with a deficient control of the hypothalamus. In the other, an appropriate control of the hypothalamus by limbic systems and prefrontal systems, via dopaminergic pathways, reduces the hyperglycemic reaction to stress. According to a psychosomatic approach, the principles of which are briefly recalled, some characterisation of mental function in IDD patients can be defined, as well as its psychiatric presentation. An improvement in mental function can be associated with a reduction in hypothalamic responses to the external or internal stimuli. An improvement in metabolic control can follow psychotherapy in such patients. Central dopaminergic pathways may play an important role in the control of anxiety and the subsequent endocrine and metabolic disorders caused by stress.