Summary
Hypoglycaemia (median venous blood glucose 1.8 mmol/l; range 1.6–2.3) was induced by an intravenous infusion of regular insulin in eight patients with Type 1 (insulin-dependent) diabetes mellitus (age 28.0±7.4 years; mean ± SD, duration 15.5±5.1 years) and in 12 age-matched healthy male control subjects. Multi-channel frequency analysis of electroencephalogram (electrophysiologic brain mapping) and recording of P300 and somatosensory evoked potentials were performed before, during and immediately after the hypoglycaemic period. The hypoglycaemia produced a significant increase in low frequency electroencephalographic activity in both groups, most pronounced over anterior regions of the brain. The electroencephalographic activity was normalised immediately after the hypoglycaemic period. The patients with diabetes showed somewhat longer P300 latencies during the initial normoglycaemic examination. Hypoglycaemia caused a marked reduction of the P300 amplitude in both groups of subjects and the amplitude was not restored immediately after normalisation of blood glucose levels. The somatosensory cortical responses were not affected by hypoglycaemia. We conclude that hypoglycaemia results in impairment in cerebral function, as measured by neurophysiological techniques, which is not immediately normalised when blood glucose is restored to normal.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Cryer PE (1988) Hypoglycemia and insulin-dependent diabetes mellitus. In: Alberti KGMM, Krall LP (eds) The diabetes annual/4. Elsevier, Amsterdam New York Oxford, pp 272–310
Kalimo H, Olsson Y (1980) Effects of severe hypoglycemia on the human brain. Neuropathological case reports. Acta Neurol Scand 62: 345–356
Agardh C-D, Kalimo H, Olsson Y, Siesjö BK (1980) Hypoglycemic brain injury. I. Metabolic and light microscopic findings in rat cerebral cortex during profound insulin-induced hypoglycemia and in the recovery period following glucose administration. Acta Neuropathol (Berlin) 50: 31–41
Auer RN, Olsson Y, Siesjö BK (1984) Hypoglycemic brain injury in the rat. Correlation of density of brain damage with the EEG isoelectric time: a quantitative study. Diabetes 33: 1090–1098
Agardh C-D, Rosen I, Ryding E (1983) Persistent vegetative state with high cerebral blood flow following profound hypoglycemia. Ann Neurol 14: 482–486
Paz-Guevara AT, Hsu T-H, White P (1975) Juvenile diabetes mellitus after forty years. Diabetes 24: 559–565
Deckert T, Poulsen JE, Larsen M (1979) The prognosis of insulin dependent diabetes mellitus and the importance of supervision. Acta Med Scand [Suppl] 624: 48–53
Harrad RA, Cockram CS, Plump AP, Stone S, Fennich P, Sönksen PH (1985) The effect of hypoglycemia on visual function: a clinical and electrophysiological study. Clin Sci 69: 673–679
De Feo P., Gallai V, Mazzotta G, Crispino G, Torlone E, Periello G, Ventura MM, Santeusanio F, Brunetti P, Bolli GB (1988) Modest decrements in plasma glucose concentration cause early impairment in cognitive function and later activation of glucose counterregulation in the absence of hypoglycemic symptoms in normal man. J Clin Invest 82: 436–444
Lager I, Attvall S, Blohme G, Smith U (1986) Altered recognition of hypoglycemic symptoms in Type I diabetes during intensified control with continuous subcutaneous insulin infusion. Diab Med 3: 322–325
Pramming S, Thorsteinsson B, Theilgaard A, Pinner EM, Binder C (1986) Cognitive function during hypoglycemia in Type I diabetes mellitus. Br Med J 292: 647–650
Holmes CS, Koepke KM, Thompson RG, Gyves PW, Weydert YA (1984) Verbal fluency and naming performances in Type I diabetes at different blood glucose concentrations. Diabetes Care 7: 454–459
Pramming S, Thorsteinsson B, Stigsby B, Binder C (1988) Glycaemic threshold for changes in electroencephalograms during hypoglycemia in patients with insulin dependent diabetes. Br Med J 296: 665–667
Luria AR (1966) Higher cortical functions in man. Tavistock, London
Verleger R (1988) Event-related potential and cognition: a critique of the context updating hypothesis and on alternative interpretation of P300. Behav Brain Sci 11: 343–357
Ruchkin DS, Sutton S (1979) CNV and P300 relationships for emitted and for evoked cerebral potentials. Prog Clin Neurophysiol 6: 119–131
Polish J (1986) Normal variation of P300 from auditory stimuli. Electroenceph Clin Neurophysiol 65: 236–240
Curry SH, Woods DL, Low MD (1986) Applications of cognitive ERPs in neurosurgical and neurological patients. In: McCallum WC, Zapoli R, Denoth F (eds) Cerebral psychophysiology: studies in event-related potential. EEG/EMG [Suppl] 38:469–484
Kiss I, Ryan CM, Mitrakou A, Jensen T, Durrant J, Gerrich JE (1989) The effects of experimentally induced hypoglycemia on neuropsychological and electrophysiological indices of cognitive function. J Clin Exp Neuropsychol 11: 77 (Abstract)
Agardh C-D, Rosen I (1983) Neurophysiological recovery after hypoglycemic coma in the rat: correlation with cerebral metabolism. J Cereb Blood Flow Metab 3: 78–85
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tallroth, G., Lindgren, M., Stenberg, G. et al. Neurophysiological changes during insulin-induced hypoglycaemia and in the recovery period following glucose infusion in Type 1 (insulin-dependent) diabetes mellitus and in normal man. Diabetologia 33, 319–323 (1990). https://doi.org/10.1007/BF00403327
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00403327