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Cognitive Impairment in Patients with Type 1 (Insulin-Dependent) Diabetes Mellitus

Incidence, Mechanisms and Therapeutic Implications

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Summary

Patients with type 1 (insulin-dependent) diabetes mellitus can experience both very low and very high blood glucose levels that may affect the CNS. Over time, high glucose levels (hyperglycaemia) may result in ketoacidosis, seizures, coma and death. Although a wide variation in response exists, acute hypoglycaemia (low blood sugar level) generally results in a decrease in the supply of glucose to the brain. Progressively lower glucose levels can result in confusion, inability to concentrate or cogitate, seizures, coma or death.

Much progress has been made in the understanding of systemic and brain glucose metabolism, and the metabolic changes that are associated with type 1 diabetes mellitus. Research during the last 2 decades has clarified specific cognitive function and cognitive deficits during glucose fluctuations, particularly hypoglycaemia. In addition, recent research efforts have attempted to differentiate between the acute and chronic influences of glycaemic level on brain physiology and function, and to determine if glucose fluctuations lead to permanent intellectual impairment. Additional studies have examined the mechanisms underlying the potentiating effect of alcohol (ethanol) on insulin-induced hypoglycaemia. Finally, clinical interventions have been developed that are directed at the prevention and early treatment of hypoglycaemia through careful management of insulin dose and timing and through extensive patient and family education.

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  1. Section on Behavioral and Mental Health Research, Joslin Diabetes Center and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA

    Katie Weinger & Alan M. Jacobson

  2. Harvard Nursing Research Institute in the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA

    Katie Weinger

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  1. Katie Weinger
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Correspondence to Katie Weinger.

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Weinger, K., Jacobson, A.M. Cognitive Impairment in Patients with Type 1 (Insulin-Dependent) Diabetes Mellitus. Mol Diag Ther 9, 233–252 (1998). https://doi.org/10.2165/00023210-199809030-00006

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