Regional brain activation during hypoglycemia in type 1 diabetes

The Journal of Clinical Endocrinology and Metabolism
Gail MusenAlan M Jacobson

Abstract

Mechanisms underlying the brain response to hypoglycemia are not well understood. Our objective was to determine the blood glucose level at which the hypothalamus and other brain regions are activated in response to hypoglycemia in type 1 diabetic patients and control subjects. This was a cross-sectional study evaluating brain activity using functional magnetic resonance imaging in conjunction with a hyperinsulinemic hypoglycemic clamp to lower glucose from euglycemia (90 mg/dl) to hypoglycemia (50 mg/dl). The study was performed at the Brain Imaging Center in the McLean Hospital. Seven type 1 diabetic patients between 18 and 50 yr old and six matched control subjects were included in the study. Hyperinsulinemic hypoglycemic clamp was performed. Blood glucose level at peak hypothalamic activation, amount of regional brain activity during hypoglycemia in both groups, and difference in regional brain activation between groups were calculated. The hypothalamic region activates at 68 +/- 9 mg/dl in control subjects and 76 +/- 8 mg/dl in diabetic patients during hypoglycemia induction. Brainstem, anterior cingulate cortex, uncus, and putamen were activated in both groups (P < 0.001). Each group also activated unique brain areas not ...Continue Reading

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Citations

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