Hypoglycemia as a complication of diabetes mellitus treatment acute eff ect on central nervous system function

Czech version

Authors: J. Michalec ¹; K. Brožová ^2,3; J. Otáhal ⁴; S. Krejčová ⁵; J. Urbanová ⁶; A. Večeřová ¹; E. Povolná ¹; J. Brož ¹
Authors‘ workplace: Interní klinika 2. LF UK a FN Motol, Praha ¹; Oddělení dětské neurologie, Fakultní Thomayerova nemocnice, Praha ²; 3. LF UK Praha ³; Ústav patologické fyziologie, 2. LF UK, Praha ⁴; Oddělení klinické psychologie, FN Motol, Praha ⁵; Interní klinika 3. LF UK a FNKV, Praha ⁶
Published in: Cesk Slov Neurol N 2024; 87(2): 89-95
Category: Review Article
doi: https://doi.org/10.48095/cccsnn202489

Overview

Hypoglycemia is a relatively common complication of diabetes mellitus treatment with insulin or with some of its secretagogues. Changes in cognitive functions have been tested by e.g. Digit Symbol Substitution Test (DSST) or Working Memory Test (WMT), whilst using functional imaging techniques – Blood-Oxygen-Level-Dependent functional MRI (BOLD-fMRI) or PET-CT. Studies have shown that during hypoglycemia, blood flow distribution through the brain can be disrupted, leading to less efficient engagement of certain brain regions in cognitive processes and lower test scores. However, there was not always the expected decrease in test scores during hypoglycemia compared to normoglycemia, or the decrease in scores was only small. This phenomenon may be explained by a correlation from imaging, where there was a compensatory increase in blood flow in the brain regions involved, and this increase was greater in hypoglycemia than in normoglycemia. Whether or not this compensation is sufficient (and therefore does not result in a worse test result) is probably individualized and depends on other factors. The areas where flow changes occurred during hypoglycemia depended on the cognitive test used. These included activating the striatum, frontostriatal pathway, and prefrontal cortex (those reflect working memory functions), or the parietal association area responsible for more complex planning processes. Conversely, impaired deactivation of brain regions irrelevant to the activity has been observed in diabetics in hypoglycemia.

Keywords:

cognitive functions – hypoglycemia – diabetes mellitus – BOLD-fMRI – PET-CT

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