Neurophysiological Impairments in IDDM Patients During Euglycemia and Hypoglycemia

Lingenfelser, Thomas; Buettner, U. W.; Sommerwerck, Urte; Renn, W.; Eggstein, M.; Jakober, B.

doi:10.2337/diacare.16.11.1438

Cited by 12 publications

(4 citation statements)

References 34 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two studies, using AEP techniques, have suggested that conduction through brain-stem structures involved in the auditory pathway was impaired during acute hypoglycaemia in non-diabetic and diabetic subjects [5,6]. In two other studies, however, brain-stem AEPs were not altered by acute hypoglycaemia in adult subjects who had Type I diabetes with strict glycaemic control [7,8] and in non-diabetic volunteers [7].…”

mentioning

confidence: 99%

Effects of acute hypoglycaemia on auditory information processing in adults with Type I diabetes

et al. 2003

View full text Add to dashboard Cite

Aims/hypothesis. Acute hypoglycaemia in humans causes general impairment of cognitive function, but information about its effects on more specific cognitive processes is limited. Methods. Basic aspects of auditory function were studied in 15 adults with uncomplicated Type I (insulin-dependent) diabetes mellitus. Two separate hyper insulinaemic glucose clamp procedures were done on different study days, in a counterbalanced fashion, either maintaining euglycaemia (blood glucose 5.0 mmol·l -1 ) or inducing hypoglycaemia (blood glucose 2.6 mmol·l -1 ). During each study, the subjects performed a battery of auditory and cognitive function tasks. Results. Hypoglycaemia caused deterioration in mental efficiency as assessed by Digit Symbol (p<0.001) and Trail Making B (p=0.004) tasks. Acute hypoglycaemia also caused deterioration in one of three measures of simple auditory processing (single-tone loudness, p=0.001) and in auditory temporal processing (p=0.007). The amplitude and latency of auditory N100, P200 and P300 event-related potentials were not affected, but the amplitude of the N240 potential was reduced during acute hypoglycaemia. Conclusion/interpretation. Our findings are consistent with other recognised disruptive effects of acute hypoglycaemia on sensory information processing in nondiabetic and diabetic adults, including adverse effects on auditory information processing in non-diabetic subjects. These derangements have implications for the everyday activities of people with Type I diabetes who are frequently exposed to acute hypoglycaemia. [Diabetologia (2003) 46:97-105] Keywords Hypoglycaemia, cognition, auditory information processing, auditory event-related potentials, Type I diabetes mellitus. . The pattern of impairment of these tests allows a general interpretation of the nature of cognitive dysfunction during hypoglycaemia, but provides little information about the impact of hypoglycaemia on specific brain processes such as basic sensory information processing.Two previous studies in our laboratory examined the ability of the brain to process visual information during acute hypoglycaemia. In one study [2] acute hypoglycaemia did not affect visual acuity or stereoscopic vision in non-diabetic subjects, but caused disPeople with Type I (insulin-dependent) diabetes mellitus are frequently exposed to episodes of acute hypoglycaemia. In experimental studies, a wide range of mental functions are impaired when arterialised blood

show abstract

mentioning

confidence: 99%

Effects of acute hypoglycaemia on auditory information processing in adults with Type I diabetes

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Neurophysiological changes have been previously described for the condition of induced hypoglycemia in both normal subjects and insulin-dependent diabetic patients (13,14,24,25). In this study, evoked potential recordings, which provide useful information regarding nervous system function, have shown a wide spectrum of abnormalities during the course of spontaneous chronic hypoglycemia in humans.…”

Section: Discussionmentioning

confidence: 86%

Effects of Spontaneous Chronic Hypoglycemia on Central and Peripheral Nervous System in Insulinoma Patients before and after Surgery: A Neurophysiological Follow-Up

Pozzessere¹,

Valle²,

D'alessio³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

View full text Add to dashboard Cite

To investigate the effects of spontaneous chronic hypoglycemia on the peripheral and central nervous system, a multimodal neurophysiological evaluation [median somatosensory (mSEP), brain stem auditory (BAEP), and visual (VEP) evoked potentials recordings] was performed in seven insulinoma patients before and 3 and 6 months after surgical removal of tumor.Before surgery, mSEP findings showed abnormal reduction in peripheral wrist-Erb conduction velocity in three patients as well as a pathological increase in Erb-N13, N13-N20, and Erb-N20 conduction times in five cases. BAEP and VEP recordings gave pathological results in two patients. Moreover, during hypoglycemia, the III-V and I-V interpeak latencies of BAEPs were significantly prolonged (P Ͻ 0.01 and P Ͻ 0.005, respectively) compared to recordings in euglycemia.After 6 months, a mSEP recovery, even if partial was noted in four patients, BAEPs were normalized in one case, and VEPs were unmodified. Compared to presurgery data, these recordings showed a significant (P Ͻ 0.05), but incomplete, shortening of BAEPs (III-V and I-V interpeak latencies) and mSEPs (Erb-N13 and Erb-N20 conduction times).Our findings demonstrate that multiple and selective neurophysiological abnormalities are present in insulinoma patients, confirm that hypoglycemia impairs suddenly brain stem function, and show that after tumor removal, long recovery times for improvement of some neurophysiological anomalies are requested. (J Clin Endocrinol Metab 82: 1447-1451, 1997) I T IS WELL known that hypoglycemia depresses cerebral energy metabolism. Thus, it is likely to cause a temporary impairment of cerebral functions and, less frequently, can produce permanent brain damage and death (1, 2). Cortical and hippocampal atrophy and ventricular enlargement may occur (3); sometimes diffuse demyelinization has been observed (3).At the peripheral level, insulin-induced hypoglycemia has been shown to produce acute axonal degeneration in both nondiabetic and diabetic animals (4) and to alter the anterograde fast components of axonal transport in rats (5). Furthermore, a distal symmetrical predominantly motor neuropathy is a rare syndrome that can occur in patients with hypoglycemia secondary to insulinoma (6 -9).During the past few years, a number of studies have examined the effects of hypoglycemia on central nervous system functions, and neurophysiological as well as neuropsychological changes have been noted (10 -14). However, the extent and mechanisms of nervous system impairment during hypoglycemia have not yet been fully described.The electrophysiological techniques potentially offer objective means of assessing peripheral and central nervous system function (15). Moreover, the recording of electrical events occurring along the somatosensory, auditory, and visual pathways constitutes a noninvasive diagnostic tool in the detection of even subclinical nervous system impairments.To our knowledge, peripheral along with central nervous system function in patients suffering from spontaneous hyp...

show abstract

“…3,4 In the recent Diabetes Control and Complication Trial (DCCT), severe hypoglycemia occurred three times more often in patients receiving a more intensive insulin regimen, sometimes without having any symptoms.…”

mentioning

confidence: 99%

“…1,2 In recent years, lack of awareness of the symptoms of hypoglycemia has been increasingly recognized as an important factor behind the occurrence of severe hypoglycemia. 3,4 In the recent Diabetes Control and Complication Trial (DCCT), severe hypoglycemia occurred three times more often in patients receiving a more intensive insulin regimen, sometimes without having any symptoms. 5 Currently, there are about 5000 diabetic patients (of all types) followed up in the Security Forces Hospital (SFH), Riyadh, as this hospital is the major referral center for Ministry of Interior employees and their relatives.…”

mentioning

confidence: 99%

Hypoglycemia among Diabetic Patients in the Accident and Emergency Department in a Saudi Hospital

Sulimani

Anani

1997

Ann Saudi Med

View full text Add to dashboard Cite

Hypoglycemia is a serious condition which affects diabetic patients. Significant hypoglycemia carries with it not only emotional issues of anxiety and embarrassment for many diabetics, but also potentially serious related problems such as convulsions, coma, and even death.1,2 In recent years, lack of awareness of the symptoms of hypoglycemia has been increasingly recognized as an important factor behind the occurrence of severe hypoglycemia. 3,4 In the recent Diabetes Control and Complication Trial (DCCT), severe hypoglycemia occurred three times more often in patients receiving a more intensive insulin regimen, sometimes without having any symptoms. 5Currently, there are about 5000 diabetic patients (of all types) followed up in the Security Forces Hospital (SFH), Riyadh, as this hospital is the major referral center for Ministry of Interior employees and their relatives.The present study was undertaken to observe the pattern of severe hypoglycemia in diabetic patients attending the Accident and Emergency (A&E) room of SFH from 1994 to 1995, the possible underlying causes and contributory factors, and the possible role of diabetic education in this pattern. Patients and MethodsData was collected on all patients with hypoglycemia (blood glucose<2.8 mmol/L) attending the A&E department at the Security Forces Hospital, from 1 May 1994 to 30 April 1995. All hospital laboratory results were input into the hospital computer system. Blood glucose levels were checked daily for hypoglycemia. Patients with hypoglycemia were interviewed by the diabetic nurse educator, and relevant clinical data recorded including age, type of diabetes, duration of disease, type of treatment, previous exposure to diabetic education, and possible etiological factors for the occurrence of hypoglycemia. ResultsIn the 12-month period of the study, 74,510 patients attended the A&E department, and 23 patients with hypoglycemia (11 males and 12 females) were identified. Only one of them attended the A&E department twice with hypoglycemic symptoms. Table 1 summarizes the age distribution of the hypoglycemic patients, with the majority aged between 50 and 70 years. Of the 23 patients, seven had insulin-dependent diabetes (IDDM), 15 had non-insulin-dependent diabetes (NIDDM), and one had gestational diabetes (GDM), which was treated with insulin. Twenty-one patients had symptomatic hypoglycemia (sweating, dizziness, hunger, palpitations and tremor). Of these, three developed symptoms in their sleep. In two patients, the hypoglycemia was apparently asymptomatic, as reported from the laboratory.Four patients were on oral hypoglycemic agents (OHA, a sulfonylurea with or without metformin), while 19 patients (6 IDDM, 12 NIDDM and 1 GDM) were on insulin (mixed split regimen). Table 2 summarizes the contributory factors for the occurrence of hypoglycemia, the most common factor being related to missing meals or snacks. Of the 23 patients, 10 were sent home after recovery, while 13 (eight patients on insulin and five on OHA) were admitted.Of the 23 patient...

show abstract

Neurophysiological Impairments in IDDM Patients During Euglycemia and Hypoglycemia

Abstract: In IDDM patients, chronic, structural CNS changes already appear at the brainstem level during euglycemia. Functional, reversible CNS changes, however, seem to emerge during acute deviation from glucose homeostasis in more rostral brain regions.

Cited by 12 publications

References 34 publications

Effects of acute hypoglycaemia on auditory information processing in adults with Type I diabetes

Effects of acute hypoglycaemia on auditory information processing in adults with Type I diabetes

Effects of Spontaneous Chronic Hypoglycemia on Central and Peripheral Nervous System in Insulinoma Patients before and after Surgery: A Neurophysiological Follow-Up

Hypoglycemia among Diabetic Patients in the Accident and Emergency Department in a Saudi Hospital

Contact Info

Product

Resources

About