Lack of preservation of higher brain function during hypoglycaemia in patients with intensively-treated IDDM
Open accessAbstract
Severe hypoglycaemia with cognitive dysfunction is 3 times more common in intensively, rather than conventionally, treated insulin-dependent diabetes mellitus (IDDM). To investigate the effect of diabetes control on higher brain function during acute hypoglycaemia, we studied one of the earliest detectable changes in cognitive function, i.e. the four-choice reaction time, and symptomatic and hormonal responses during euglycaemic and hypoglycaemic clamping in human subjects. There were no changes in symptoms or counterregulatory hormones and four-choice reaction time was stable during 220 min of euglycaemic insulin clamping in five men with IDDM, with a coefficient of variation of less than 2.2% (1% for accuracy) for the cognitive function test. During stepped hypoglycaemic clamping however, hormonal responses and subjective awareness of hypoglycaemia occurred in all groups but started at much lower blood glucose concentrations in eight intensively-treated diabetic subjects (Group 1) than in ten conventionally-treated (Group 2) or in eight non-diabetic subjects (Group 3). For example, for adrenaline, plasma glucose thresholds were 2.7 +/- 0.2 vs 3.4 +/- 0.2 and 3.2 +/- 0.1 mmol/l, respectively, p < 0.05, Group 1 vs Groups 2 or 3 and for subjective awareness of hypoglycaemia 2.3 +/- 0.2 vs 3.0 +/- 0.1 and 3.2 +/- 0.1 mmol/l, p < or = 0.003), as in previous studies. In contrast, deterioration in reaction time occurred at 3.2 +/- 0.3, 3.2 +/- 0.2 and 3.0 +/- 0.2 mmol/l, respectively (p = NS), thus occurring at higher glucose levels than subjective awareness in the intensively-treated subjects only. The altered hierarchy of responses to hypoglycaemia in well-controlled intensively-treated diabetes explains the increased risk of severe hypoglycaemia without warning seen in such patients.
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Consumption of high-glycaemic index carbohydrates in the hour before exercise has been reported to lower blood glucose concentrations 15-30 min after starting exercise.
“consumption of high-glycaemic index carbohydrates in the hour before exercise has also been reported to lower blood glucose concentrations 15-30 min after starting exercise 47, 57”
From Half-time strategies to enhance second-half performance in team-sports players: A review and recommendations (2015) · cites this paper as [57]
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- Authors
- Maran, A., Lomas, J., Macdonald, I. A., & Amiel, S. A.
- Affiliations
- Guy's Hospital (GB)
- University of Nottingham (GB)
- Venue
- Diabetologia
- Published
- 1995-12
- Volume
- 38
- Issue
- 12
- Pages
- 1412-1418
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2021592528
- Cited by
- 102
- References
- 39
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 4 · 2021: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2015: 7 · 2014: 6 · 2013: 10 · 2012: 6
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- Leverhulme Trust
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Keywords
- hypoglycemia, type 1 diabetes, intensive insulin therapy, cognitive function, reaction time, epinephrine, counterregulatory hormones, blood glucose threshold, diabetes management
- MeSH terms
- Adult, Analysis of Variance, Awareness, Blood Glucose, Cognition, Cognition Disorders, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Insulin, Male, Surveys and Questionnaires, Reaction Time, Time Factors, Glucose Clamp Technique
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