TY - JOUR
T1 - Cognitive performance, symptoms and counter-regulation during hypoglycaemia in patients with type 1 diabetes and high or low renin-angiotensin system activity
AU - Høi-Hansen, Thomas
AU - Pedersen-Bjergaard, Ulrik
AU - Andersen, Rikke Due
AU - Kristensen, Peter Lommer
AU - Thomsen, Carsten
AU - Kjaer, Troels
AU - Høgenhaven, Hans
AU - Smed, Annelise
AU - Holst, Jens Juul
AU - Dela, Flemming
AU - Boomsma, Frans
AU - Thorsteinsson, Birger
AU - Høi-Hansen, Thomas
AU - Pedersen-Bjergaard, Ulrik
AU - Andersen, Rikke Due
AU - Kristensen, Peter Lommer
AU - Thomsen, Carsten
AU - Kjaer, Troels
AU - Høgenhaven, Hans
AU - Smed, Annelise
AU - Holst, Jens Juul
AU - Dela, Flemming
AU - Boomsma, Frans
AU - Thorsteinsson, Birger
N1 - Keywords: Adult; Blood Glucose; Cognition; Diabetes Mellitus, Type 1; Electroencephalography; Evoked Potentials, Auditory; Female; Humans; Hypoglycemia; Insulin; Male; Middle Aged; Psychomotor Performance; Renin-Angiotensin System
PY - 2009
Y1 - 2009
N2 - INTRODUCTION: High basal renin-angiotensin system (RAS) activity is associated with increased risk of severe hypoglycaemia in type 1 diabetes. We tested whether this might be explained by more pronounced cognitive dysfunction during hypoglycaemia in patients with high RAS activity than in patients with low RAS activity. MATERIALS AND METHODS: Nine patients with type 1 diabetes and high and nine with low RAS activity were subjected to hypoglycaemia and euglycaemia in a cross-over study using an intravenous insulin infusion protocol. Cognitive function, electroencephalography, auditory evoked potentials and hypoglycaemic symptoms were recorded. RESULTS: At a hypoglycaemic nadir of 2.2 (SD 0.3) mmol/L the high RAS group displayed significant deterioration in cognitive performance during hypoglycaemia in the three most complex reaction time tasks. In the low RAS group, hypoglycaemia led to cognitive dysfunction in only one reaction time task. The high RAS group reported lower symptom scores during hypoglycaemia than the low RAS group, suggesting poorer hypoglycaemia awareness. CONCLUSION: High RAS activity is associated with increased cognitive dysfunction and blunted symptoms during mild hypoglycaemia compared to low RAS activity. This may explain why high RAS activity is a risk factor for severe hypoglycaemia in type 1 diabetes.
AB - INTRODUCTION: High basal renin-angiotensin system (RAS) activity is associated with increased risk of severe hypoglycaemia in type 1 diabetes. We tested whether this might be explained by more pronounced cognitive dysfunction during hypoglycaemia in patients with high RAS activity than in patients with low RAS activity. MATERIALS AND METHODS: Nine patients with type 1 diabetes and high and nine with low RAS activity were subjected to hypoglycaemia and euglycaemia in a cross-over study using an intravenous insulin infusion protocol. Cognitive function, electroencephalography, auditory evoked potentials and hypoglycaemic symptoms were recorded. RESULTS: At a hypoglycaemic nadir of 2.2 (SD 0.3) mmol/L the high RAS group displayed significant deterioration in cognitive performance during hypoglycaemia in the three most complex reaction time tasks. In the low RAS group, hypoglycaemia led to cognitive dysfunction in only one reaction time task. The high RAS group reported lower symptom scores during hypoglycaemia than the low RAS group, suggesting poorer hypoglycaemia awareness. CONCLUSION: High RAS activity is associated with increased cognitive dysfunction and blunted symptoms during mild hypoglycaemia compared to low RAS activity. This may explain why high RAS activity is a risk factor for severe hypoglycaemia in type 1 diabetes.
U2 - 10.1177/1470320309343007
DO - 10.1177/1470320309343007
M3 - Journal article
C2 - 19717500
SN - 1470-3203
VL - 10
SP - 216
EP - 229
JO - Journal of the Renin-Angiotensin-Aldosterone System
JF - Journal of the Renin-Angiotensin-Aldosterone System
IS - 4
ER -
