Adaptation of cognitive function to hypoglycemia in healthy men

• Published in: Diabetes care Vol. 23; no. 8; pp. 1059 - 1066
• Main Authors: Fruehwald-Schultes, B, Born, J, Kern, W, Peters, A, Fehm, H L
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.08.2000
• Subjects: Adaptation, Physiological; Adult; Arousal; Biological and medical sciences; Blood Glucose - metabolism; Brain research; Cognition - physiology; Cognition Disorders - etiology; Cognitive ability; Diabetes; Drug toxicity and drugs side effects treatment; Electrodes; Emotions; Epinephrine - blood; Experiments; Fatigue; Glucose; Glucose Clamp Technique; Human Growth Hormone - blood; Humans; Hydrocortisone - blood; Hypoglycemia; Hypoglycemia - physiopathology; Hypoglycemia - psychology; Insulin; Male; Medical research; Medical sciences; Memory; Memory, Short-Term - physiology; Norepinephrine - blood; Pharmacology. Drug treatments; Plasma; Reaction Time - physiology; Regression Analysis; Research design; Surveys and Questionnaires; Toxicity: nervous system and muscle; Germany; Human; Short term; Relapse; Cognitive disorder; Toxicity; Memory; Male; Experimental study; Hypoglycemia; Insulin; Electrodiagnosis; Hypoglycemic agent; Auditory evoked potential; Adult; Antecedent
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.23.8.1059

Adaptation of cognitive function to hypoglycemia in healthy men. B Fruehwald-Schultes , J Born , W Kern , A Peters and H L Fehm Department of Internal Medicine, University of Luebeck, Germany. fruehwal@kfg.mu-luebeck.de Abstract OBJECTIVE: Antecedent hypoglycemia reduces hypoglycemic counterregulation and symptoms, thereby provoking the hypoglycemia unawareness syndrome. The effects of antecedent hypoglycemia on hypoglycemia-induced cognitive dysfunction are less well established. RESEARCH DESIGN AND METHODS: To determine whether antecedent hypoglycemia also reduces hypoglycemic cognitive dysfunction, we performed stepwise hypoglycemic clamp experiments (4.1, 3.6, 3.1, and 2.6 mmol/l) during a 6-h period in 30 young healthy men. A total of 15 subjects additionally received a 2.5-h antecedent hypoglycemic clamp (3.1 mmol/l) on the preceding day (prior-hypo group), whereas the other 15 subjects did not (control group). Cognitive function was assessed by auditory-evoked brain potentials (AEBPs) and reaction time during a vigilance task and short-term memory recall. Tests were performed during the stepwise hypoglycemic clamp at baseline and at each hypoglycemic plateau. RESULTS: In both groups, performance on all measures of cognitive function deteriorated during stepwise hypoglycemia (all P < 0.01). However, after antecedent hypoglycemia, the hypoglycemia-induced decrease in the amplitude of the P3 of the AEBP was distinctly reduced compared with the control condition (P < 0.05). Also, short-term memory performance was less impaired in the prior-hypo group than in the control group (P < 0.005), and a minor hypoglycemic impairment of reaction time (P < 0.05) was evident in the prior-hypo group. CONCLUSIONS: Data provide evidence that a single episode of mild antecedent hypoglycemia (3.1 mmol/l) attenuates several aspects of cognitive dysfunction during subsequent hypoglycemia 18-24 h later.