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Neurophysiological impairments in IDDM patients during euglycemia and hypoglycemia
T Lingenfelser1, U W Buettner, U Sommerwerck
1Department of Medicine, Eberhard-Karls University Tuebingen, Germany.
Diabetes Care
|November 1, 1993
Summary
Evoked potential latencies are delayed in patients with insulin-dependent diabetes mellitus (IDDM) even with normal blood sugar. Hypoglycemia causes further delays, indicating central nervous system (CNS) changes.
Area of Science:
- Neuroscience
- Endocrinology
- Diabetology
Background:
- Insulin-dependent diabetes mellitus (IDDM) is associated with neurological complications.
- Evoked potentials are sensitive measures of neural pathway function.
Purpose of the Study:
- To investigate if evoked potential latencies are delayed in IDDM patients compared to healthy controls during normal blood glucose levels (euglycemia).
- To determine if insulin-induced hypoglycemia further delays evoked potential latencies in IDDM patients.
Main Methods:
- A prospective study comparing 23 IDDM patients (without neuropathy) and 26 healthy controls.
- Sequential euglycemic-hypoglycemic clamps were used to maintain stable glucose levels (5.6 to 1.7 mM).
- Brainstem auditory, middle-latency auditory, and somatosensory evoked potentials were measured to assess neural conduction and processing.
Main Results:
- Brainstem auditory evoked potential latencies were significantly delayed in IDDM patients during euglycemia, particularly wave III, V, and interpeak latency I-V.
- Middle-latency auditory evoked potential (Pa wave) latencies were significantly delayed during hypoglycemia in IDDM patients.
- These hypoglycemic-induced delays rapidly normalized upon return to euglycemia.
Conclusions:
- IDDM patients exhibit chronic, structural central nervous system (CNS) changes at the brainstem level even during euglycemia.
- Acute deviations from glucose homeostasis, such as hypoglycemia, induce functional, reversible CNS changes in more rostral brain regions.