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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1994 Nov;57(11):1360–1365. doi: 10.1136/jnnp.57.11.1360

Brain metabolism after recurrent insulin induced hypoglycaemic episodes: a PET study.

H Chabriat 1, C Sachon 1, M Levasseur 1, A Grimaldi 1, S Pappata 1, D Rougemont 1, M C Masure 1, A De Recondo 1, Y Samson 1
PMCID: PMC1073187  PMID: 7964812

Abstract

Neuropsychological testing was carried out and the rate of oxygen metabolism in the brain was measured by PET in 15 highly selected patients with type 1 diabetes. The aim was to investigate the impact on the brain of hypoglycaemic comas resulting from insulin treatment. No significant difference was found between nine patients with a history of more than 10 hypoglycaemic comas and six others who denied any history of such events. These data suggest that intensified insulin treatment, although increasing the frequency of hypoglycaemic coma, may not always be harmful for the brain. This may be explained by the limited duration of hypoglycaemic coma induced by conventional insulin treatment.

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Selected References

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  1. Anderson J. M., Milner R. D., Strich S. J. Effects of neonatal hypoglycaemia on the nervous system: a pathological study. J Neurol Neurosurg Psychiatry. 1967 Aug;30(4):295–310. doi: 10.1136/jnnp.30.4.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Auer R. N., Kalimo H., Olsson Y., Siesjö B. K. The temporal evolution of hypoglycemic brain damage. I. Light- and electron-microscopic findings in the rat cerebral cortex. Acta Neuropathol. 1985;67(1-2):13–24. doi: 10.1007/BF00688120. [DOI] [PubMed] [Google Scholar]
  3. Auer R. N., Kalimo H., Olsson Y., Siesjö B. K. The temporal evolution of hypoglycemic brain damage. II. Light- and electron-microscopic findings in the hippocampal gyrus and subiculum of the rat. Acta Neuropathol. 1985;67(1-2):25–36. doi: 10.1007/BF00688121. [DOI] [PubMed] [Google Scholar]
  4. Auer R. N., Kalimo H., Olsson Y., Siesjö B. K. The temporal evolution of hypoglycemic brain damage. II. Light- and electron-microscopic findings in the hippocampal gyrus and subiculum of the rat. Acta Neuropathol. 1985;67(1-2):25–36. doi: 10.1007/BF00688121. [DOI] [PubMed] [Google Scholar]
  5. Auer R. N., Olsson Y., Siesjö B. K. Hypoglycemic brain injury in the rat. Correlation of density of brain damage with the EEG isoelectric time: a quantitative study. Diabetes. 1984 Nov;33(11):1090–1098. doi: 10.2337/diab.33.11.1090. [DOI] [PubMed] [Google Scholar]
  6. Auer R. N., Siesjö B. K. Biological differences between ischemia, hypoglycemia, and epilepsy. Ann Neurol. 1988 Dec;24(6):699–707. doi: 10.1002/ana.410240602. [DOI] [PubMed] [Google Scholar]
  7. Auer R. N., Wieloch T., Olsson Y., Siesjö B. K. The distribution of hypoglycemic brain damage. Acta Neuropathol. 1984;64(3):177–191. doi: 10.1007/BF00688108. [DOI] [PubMed] [Google Scholar]
  8. Bale R. N. Brain damage in diabetes mellitus. Br J Psychiatry. 1973 Mar;122(568):337–341. doi: 10.1192/bjp.122.3.337. [DOI] [PubMed] [Google Scholar]
  9. Baron J. C., D'Antona R., Pantano P., Serdaru M., Samson Y., Bousser M. G. Effects of thalamic stroke on energy metabolism of the cerebral cortex. A positron tomography study in man. Brain. 1986 Dec;109(Pt 6):1243–1259. doi: 10.1093/brain/109.6.1243. [DOI] [PubMed] [Google Scholar]
  10. Blin J., Baron J. C., Dubois B., Pillon B., Cambon H., Cambier J., Agid Y. Positron emission tomography study in progressive supranuclear palsy. Brain hypometabolic pattern and clinicometabolic correlations. Arch Neurol. 1990 Jul;47(7):747–752. doi: 10.1001/archneur.1990.00530070035009. [DOI] [PubMed] [Google Scholar]
  11. Bowen B. C., Barker W. W., Loewenstein D. A., Sheldon J., Duara R. MR signal abnormalities in memory disorder and dementia. AJR Am J Roentgenol. 1990 Jun;154(6):1285–1292. doi: 10.2214/ajr.154.6.2110743. [DOI] [PubMed] [Google Scholar]
  12. Choi H., Ho K. C., Luprecht G. L. Chromatin-negative Klinefelter's syndrome with focal megalencephaly. Acta Neurol Scand. 1980 Dec;62(6):357–367. doi: 10.1111/j.1600-0404.1980.tb03048.x. [DOI] [PubMed] [Google Scholar]
  13. Cryer P. E., Binder C., Bolli G. B., Cherrington A. D., Gale E. A., Gerich J. E., Sherwin R. S. Hypoglycemia in IDDM. Diabetes. 1989 Sep;38(9):1193–1199. doi: 10.2337/diab.38.9.1193. [DOI] [PubMed] [Google Scholar]
  14. Cryer P. E. Iatrogenic hypoglycemia as a cause of hypoglycemia-associated autonomic failure in IDDM. A vicious cycle. Diabetes. 1992 Mar;41(3):255–260. doi: 10.2337/diab.41.3.255. [DOI] [PubMed] [Google Scholar]
  15. Fiorelli M., Duboc D., Mazoyer B. M., Blin J., Eymard B., Fardeau M., Samson Y. Decreased cerebral glucose utilization in myotonic dystrophy. Neurology. 1992 Jan;42(1):91–94. doi: 10.1212/wnl.42.1.91. [DOI] [PubMed] [Google Scholar]
  16. Frackowiak R. S., Lenzi G. L., Jones T., Heather J. D. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr. 1980 Dec;4(6):727–736. doi: 10.1097/00004728-198012000-00001. [DOI] [PubMed] [Google Scholar]
  17. Frackowiak R. S., Pozzilli C., Legg N. J., Du Boulay G. H., Marshall J., Lenzi G. L., Jones T. Regional cerebral oxygen supply and utilization in dementia. A clinical and physiological study with oxygen-15 and positron tomography. Brain. 1981 Dec;104(Pt 4):753–778. doi: 10.1093/brain/104.4.753. [DOI] [PubMed] [Google Scholar]
  18. Frith C. D., Friston K. J., Liddle P. F., Frackowiak R. S. A PET study of word finding. Neuropsychologia. 1991;29(12):1137–1148. doi: 10.1016/0028-3932(91)90029-8. [DOI] [PubMed] [Google Scholar]
  19. Gerich J. E., Mokan M., Veneman T., Korytkowski M., Mitrakou A. Hypoglycemia unawareness. Endocr Rev. 1991 Nov;12(4):356–371. doi: 10.1210/edrv-12-4-356. [DOI] [PubMed] [Google Scholar]
  20. Ghajar J. B., Plum F., Duffy T. E. Cerebral oxidative metabolism and blood flow during acute hypoglycemia and recovery in unanesthetized rats. J Neurochem. 1982 Feb;38(2):397–409. doi: 10.1111/j.1471-4159.1982.tb08643.x. [DOI] [PubMed] [Google Scholar]
  21. Grimaldi A., Bosquet F., Davidoff P., Digy J. P., Sachon C., Landault C., Thervet F., Zoghbi F., Legrand J. C. Unawareness of hypoglycemia by insulin-dependent diabetics. Horm Metab Res. 1990 Feb;22(2):90–95. doi: 10.1055/s-2007-1004858. [DOI] [PubMed] [Google Scholar]
  22. Inoue T., Kato H., Araki T., Kogure K. Emphasized selective vulnerability after repeated nonlethal cerebral ischemic insults in rats. Stroke. 1992 May;23(5):739–745. doi: 10.1161/01.str.23.5.739. [DOI] [PubMed] [Google Scholar]
  23. Iwai A., Sakamoto T., Kinoshita Y., Yokota J., Yoshioka T., Sugimoto T. Computed tomographic imaging of the brain in after hypoglycemia coma. Neuroradiology. 1987;29(4):398–400. doi: 10.1007/BF00348923. [DOI] [PubMed] [Google Scholar]
  24. Langan S. J., Deary I. J., Hepburn D. A., Frier B. M. Cumulative cognitive impairment following recurrent severe hypoglycaemia in adult patients with insulin-treated diabetes mellitus. Diabetologia. 1991 May;34(5):337–344. doi: 10.1007/BF00405006. [DOI] [PubMed] [Google Scholar]
  25. Laplane D., Levasseur M., Pillon B., Dubois B., Baulac M., Mazoyer B., Tran Dinh S., Sette G., Danze F., Baron J. C. Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. Brain. 1989 Jun;112(Pt 3):699–725. doi: 10.1093/brain/112.3.699. [DOI] [PubMed] [Google Scholar]
  26. Lebrun-Grandié P., Baron J. C., Soussaline F., Loch'h C., Sastre J., Bousser M. G. Coupling between regional blood flow and oxygen utilization in the normal human brain. A study with positron tomography and oxygen 15. Arch Neurol. 1983 Apr;40(4):230–236. doi: 10.1001/archneur.1983.04050040060010. [DOI] [PubMed] [Google Scholar]
  27. Malouf R., Brust J. C. Hypoglycemia: causes, neurological manifestations, and outcome. Ann Neurol. 1985 May;17(5):421–430. doi: 10.1002/ana.410170502. [DOI] [PubMed] [Google Scholar]
  28. Norberg K., Siesiö B. K. Oxidative metabolism of the cerebral cortex of the rat in severe insulin-induced hypoglycaemia. J Neurochem. 1976 Feb;26(2):345–352. doi: 10.1111/j.1471-4159.1976.tb04487.x. [DOI] [PubMed] [Google Scholar]
  29. PORTA P. D., MAIOLO A. T., NEGRI V. U., ROSSELLA E. CEREBRAL BLOOD FLOW AND METABOLISM IN THERAPEUTIC INSULIN COMA. Metabolism. 1964 Feb;13:131–140. doi: 10.1016/0026-0495(64)90126-x. [DOI] [PubMed] [Google Scholar]
  30. Pantano P., Baron J. C., Crouzel C., Collard P., Sirou P., Samson Y. The 15O continuous-inhalation method: correction for intravascular signal using C15O. Eur J Nucl Med. 1985;10(9-10):387–391. doi: 10.1007/BF00256576. [DOI] [PubMed] [Google Scholar]
  31. Pardo J. V., Pardo P. J., Janer K. W., Raichle M. E. The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proc Natl Acad Sci U S A. 1990 Jan;87(1):256–259. doi: 10.1073/pnas.87.1.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Reichard P., Berglund A., Britz A., Levander S., Rosenqvist U. Hypoglycaemic episodes during intensified insulin treatment: increased frequency but no effect on cognitive function. J Intern Med. 1991 Jan;229(1):9–16. doi: 10.1111/j.1365-2796.1991.tb00299.x. [DOI] [PubMed] [Google Scholar]
  33. Reichard P., Rosenqvist U. Nephropathy is delayed by intensified insulin treatment in patients with insulin-dependent diabetes mellitus and retinopathy. J Intern Med. 1989 Aug;226(2):81–87. doi: 10.1111/j.1365-2796.1989.tb01359.x. [DOI] [PubMed] [Google Scholar]
  34. Ryan C. M., Williams T. M., Finegold D. N., Orchard T. J. Cognitive dysfunction in adults with type 1 (insulin-dependent) diabetes mellitus of long duration: effects of recurrent hypoglycaemia and other chronic complications. Diabetologia. 1993 Apr;36(4):329–334. doi: 10.1007/BF00400236. [DOI] [PubMed] [Google Scholar]
  35. Sachon C., Grimaldi A., Digy J. P., Pillon B., Dubois B., Thervet F. Cognitive function, insulin-dependent diabetes and hypoglycaemia. J Intern Med. 1992 May;231(5):471–475. doi: 10.1111/j.1365-2796.1992.tb00962.x. [DOI] [PubMed] [Google Scholar]
  36. Theodore W. H., Dorwart R., Holmes M., Porter R. J., DiChiro G. Neuroimaging in refractory partial seizures: comparison of PET, CT, and MRI. Neurology. 1986 Jun;36(6):750–759. doi: 10.1212/wnl.36.6.750. [DOI] [PubMed] [Google Scholar]
  37. Turkington R. W. Encephalopathy induced by oral hypoglycemic drugs. Arch Intern Med. 1977 Aug;137(8):1082–1083. [PubMed] [Google Scholar]
  38. Wredling R., Levander S., Adamson U., Lins P. E. Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man. Diabetologia. 1990 Mar;33(3):152–157. doi: 10.1007/BF00404042. [DOI] [PubMed] [Google Scholar]

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