Mechanisms underlying cognitive dysfunction in young diabetic children are poorly understood, and may include synaptic dysfunction from insulin-induced hypoglycemia. We developed a model of repetitive insulin-induced hypoglycemia in young rats and examined hippocampal long-term potentiation, an electrophysiologic assay of synaptic plasticity, 3-5 d after the last hypoglycemic event. Three hypoglycemic events between postnatal d 21-25 produced modest cortical (17 Ϯ 2.9 dead neurons per section in parasagittal cortex), but not hippocampal, neuron death quantified by Fluoro-Jade B staining. There was no change in neurogenesis in the hippocampal dentate granule cell region by quantification of bromodeoxyuridine incorporation. Although normal baseline hippocampal synaptic responses were elicited from hippocampal slices from hypoglycemic animals, long-term synaptic potentiation could not be induced in hippocampal slices from rats subjected to hypoglycemia. These results suggest that repetitive hypoglycemia in the developing brain can cause selective impairment of synaptic plasticity in the absence of cell death, and without complete disruption of basal synaptic transmission. We speculate that impaired synaptic plasticity in the hippocampus caused by repetitive hypoglycemia could underlie memory and cognitive deficits observed in young diabetic children, and that cortical neuron death caused by repetitive hypoglycemia in the developing brain may contribute to other neurologic, cognitive, and psychological problems sometimes encountered in diabetic children. (Pediatr Res 55: 372-379, 2004) Abbreviations LTP, long-term potentiation Hex, hexamethonium chloride HI, hexamethonium chloride plus insulin EPSP, excitatory postsynaptic potential BrdU, bromodeoxyuridine PBS؉, PBS with 10% goat serum and 0.3% Triton X DAPI, 4',6-diamidino-2-phenylindole Diabetic children diagnosed before age 5 y are at risk for lasting cognitive impairment (1), and hypoglycemia may be a causative factor (2, 3). Young children on conventional therapy are prone to hypoglycemic events (4 -8), which occur even more frequently on intensive therapy (9, 10). Severe hypoglycemia was a risk factor for cognitive deficits in one prospective study (11), but not another (12), raising the possibility that less severe, repetitive hypoglycemia (not evaluated in these studies) causes cognitive impairment. Moreover, continuous glucose monitoring reveals that prolonged nocturnal hypoglycemia occurs frequently in children with type 1 diabetes (13,14). The mechanisms by which diabetes or hypoglycemia produce relatively subtle cognitive deficits without overt brain injury are poorly understood, and these two factors are difficult to study independently in diabetic children. Therefore, we developed a model of hypoglycemia-induced brain injury in developing rats to simulate repetitive hypoglycemia as encountered in diabetic children to study the consequences of repetitive hypoglycemia at a cellular level under more controlled experimental conditions.