PURPOSE.Mice rendered hypoglycemic by a null mutation in the glucagon receptor gene Gcgr display late-onset retinal degeneration and loss of retinal sensitivity. Acute hyperglycemia induced by dextrose ingestion does not restore their retinal function, which is consistent with irreversible loss of vision. The goal of this study was to establish whether long-term administration of high dietary glucose rescues retinal function and circuit connectivity in aged Gcgr Ϫ/Ϫ mice.
METHODS.Gcgr Ϫ/Ϫ mice were administered a carbohydraterich diet starting at 12 months of age. After 1 month of treatment, retinal function and structure were evaluated using electroretinographic (ERG) recordings and immunohistochemistry. RESULTS. Treatment with a carbohydrate-rich diet raised blood glucose levels and improved retinal function in Gcgr Ϫ/Ϫ mice. Blood glucose increased from moderate hypoglycemia to euglycemic levels, whereas ERG b-wave sensitivity improved approximately 10-fold. Because the b-wave reflects the electrical activity of second-order cells, we examined for changes in rod-to-bipolar cell synapses. Gcgr Ϫ/Ϫ retinas have 20% fewer synaptic pairings than Gcgr ϩ/Ϫ retinas. Remarkably, most of the lost synapses were located farthest from the bipolar cell body, near the distal boundary of the outer plexiform layer (OPL), suggesting that apical synapses are most vulnerable to chronic hypoglycemia. Although treatment with the carbohydrate-rich diet restored retinal function, it did not restore these synaptic contacts. CONCLUSIONS. Prolonged exposure to diet-induced euglycemia improves retinal function but does not reestablish synaptic contacts lost by chronic hypoglycemia. These results suggest that retinal neurons have a homeostatic mechanism that integrates energetic status over prolonged periods of time and allows them to recover functionality despite synaptic loss. T he retina is among the most metabolically active tissues in the body, requiring a constant supply of blood glucose to sustain glycolysis, oxidative metabolism, and retinal function.1-6 The sensitivity of the retina to glucose is underscored by the observations that acute hypoglycemia decreases rod 7 and cone vision, 8 -10 blurs central vision, and produces temporary central scotomas.10,11 Dietary hyperglycemia can rapidly counteract these effects of acute hypoglycemia and restore retinal function.
12The consequence of sustained hypoglycemia on retinal function is less clear. Hypoglycemia is a common condition caused by poor nutrition, 13 inborn errors of metabolism, 14 and pancreatic tumors, 15 and it is a frequent complication of diabetes medications. 16 Our goal in this study was to understand the effects of sustained hypoglycemia on retinal and visual function. To this purpose we examined mice rendered chronically hypoglycemic by a null mutation in the glucagon receptor gene, Gcgr.17 Gcgr Ϫ/Ϫ mice are moderately hypoglycemic and experience late-onset retinal degeneration with loss of vision.18 Their retinal function (as assessed by the electroretinographic ...