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Protection by lactate of cerebral function during hypoglycaemia
1Unit for Metabolic Medicine, United Medical School of Guy's Hospital, London, UK.
Lancet (London, England)
|January 1, 1994
Summary
Infusing lactate, a brain fuel, protected brain function during severe hypoglycemia in healthy men. This finding suggests potential new therapies for managing blood sugar in diabetes.
Area of Science:
- Endocrinology
- Neuroscience
- Metabolism
Background:
- Intensified therapy for insulin-dependent diabetes mellitus (IDDM) is limited by severe hypoglycemia and brain dysfunction.
- Evidence suggests intensified therapy reduces chronic diabetes complications.
- Alternative brain fuels may mitigate hypoglycemia's adverse effects.
Purpose of the Study:
- To investigate the effect of lactate infusion on neurohumoral and symptomatic responses during hypoglycemia.
- To assess lactate's impact on brain function during experimentally induced hypoglycemia.
- To explore lactate as a potential protective agent against hypoglycemia-induced brain dysfunction.
Main Methods:
- Seven healthy men underwent controlled hyperinsulinemic hypoglycemia.
- Lactate was infused to maintain physiological levels.
- Neurohumoral counter-regulatory responses (catecholamines, growth hormone, cortisol, glucagon) were measured.
- Symptomatic responses and cognitive function (brain function) were assessed.
- Glucose levels triggering responses and brain dysfunction were identified.
Main Results:
- Lactate infusion significantly reduced catecholamine, growth hormone, and cortisol responses to hypoglycemia.
- Lactate lowered the glucose threshold for initiating these counter-regulatory responses.
- Glucagon responses remained unaffected by lactate infusion.
- Lactate was associated with a lower glucose level at which cerebral cortical dysfunction occurred, indicating brain protection.
- The observed counter-regulatory defect mirrors that in hypoglycemia-prone diabetic patients.
Conclusions:
- Supporting brain metabolism with an alternative fuel like lactate can delay counter-regulatory responses (except glucagon) and cerebral dysfunction during severe hypoglycemia.
- This demonstrates that higher brain function can be protected during hypoglycemia, suggesting therapeutic potential for managing diabetes.
- Findings may inform strategies to enable safer intensified glucose control in insulin-dependent diabetes mellitus.