scholarly journals Impaired Awareness of Hypoglycemia Disrupts Blood Flow to Brain Regions Involved in Arousal and Decision Making in Type 1 Diabetes

Diabetes Care ◽  
2019 ◽  
Vol 42 (11) ◽  
pp. 2127-2135 ◽  
Author(s):  
Munachiso Nwokolo ◽  
Stephanie A. Amiel ◽  
Owen O’Daly ◽  
Megan L. Byrne ◽  
Bula M. Wilson ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Flow ◽  
Type 1 Diabetes ◽  
Brain Regions ◽  
Impaired Awareness

scholarly journals Cerebral blood flow response to hypoglycemia is altered in patients with type 1 diabetes and impaired awareness of hypoglycemia

2016 ◽  
Vol 37 (6) ◽  
pp. 1994-2001 ◽  
Author(s):  
Evita C Wiegers ◽  
Kirsten M Becker ◽  
Hanne M Rooijackers ◽  
Federico C von Samson-Himmelstjerna ◽  
Cees J Tack ◽  
...  
Keyword(s):  
Blood Flow ◽  
Type 1 Diabetes ◽  
Cerebral Blood Flow ◽  
Brain Regions ◽  
Autonomic Response ◽  
Healthy Controls ◽  
Impaired Awareness ◽  
Global Cerebral Blood Flow ◽  
Diabetes Patients

It is unclear whether cerebral blood flow responses to hypoglycemia are altered in people with type 1 diabetes and impaired awareness of hypoglycemia. The aim of this study was to investigate the effect of hypoglycemia on both global and regional cerebral blood flow in type 1 diabetes patients with impaired awareness of hypoglycemia, type 1 diabetes patients with normal awareness of hypoglycemia and healthy controls ( n = 7 per group). The subjects underwent a hyperinsulinemic euglycemic–hypoglycemic glucose clamp in a 3 T MR system. Global and regional changes in cerebral blood flow were determined by arterial spin labeling magnetic resonance imaging, at the end of both glycemic phases. Hypoglycemia generated typical symptoms in patients with type 1 diabetes and normal awareness of hypoglycemia and healthy controls, but not in patients with impaired awareness of hypoglycemia. Conversely, hypoglycemia increased global cerebral blood flow in patients with impaired awareness of hypoglycemia, which was not observed in the other two groups. Regionally, hypoglycemia caused a redistribution of cerebral blood flow towards the thalamus of both patients with normal awareness of hypoglycemia and healthy controls, consistent with activation of brain regions associated with the autonomic response to hypoglycemia. No such redistribution was found in the patients with impaired awareness of hypoglycemia. An increase in global cerebral blood flow may enhance nutrient supply to the brain, hence suppressing symptomatic awareness of hypoglycemia. Altogether these results suggest that changes in cerebral blood flow during hypoglycemia contribute to impaired awareness of hypoglycemia.

scholarly journals Restoration of Hypoglycemia Awareness Alters Brain Activity in Type 1 Diabetes

2020 ◽  
Author(s):  
Munachiso Nwokolo ◽  
Stephanie A. Amiel ◽  
Owen O’Daly ◽  
Ian A. Macdonald ◽  
Fernando O. Zelaya ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Flow ◽  
Type 1 Diabetes ◽  
Anterior Cingulate ◽  
Partial Recovery ◽  
Post Intervention ◽  
Pump Therapy ◽  
Brain Responses ◽  
The Impact

Objective <p>Impaired awareness of hypoglycemia (IAH) in type 1 diabetes (T1D) is a major risk factor for severe hypoglycemia (SH), and is associated with atypical responses to hypoglycemia in brain regions involved in arousal, decision-making and memory. Whether restoration of hypoglycemia awareness alters these responses is unknown. We sought to investigate the impact of awareness restoration on brain responses to hypoglycemia.</p> <p> </p> <p>Research Design and Methods</p> <p>Twelve T1D IAH adults underwent pseudo-continuous arterial spin labelling functional MRI during a hypoglycemic clamp (5mmol/L-2.6mmol/L), before and after a hypoglycemia avoidance program of structured education (Dose Adjustment for Normal Eating, DAFNE), specialist support and sensor-augmented pump therapy (Medtronic Minimed™ 640G). Hypoglycemic cerebral blood flow (CBF) responses were compared pre- and post-intervention using predefined region of interest analysis of the thalamus, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC) and hippocampus.</p> <p> </p> <p>Results</p> <p>Post-intervention, Gold and Clarke scores fell (6.0±1.0 to 4.0±1.6, p=0.0002; 5.7±1.7 to 3.4±1.8, p=0.0008), SH rates reduced (1.5±2 to 0.3±0.5 episodes per year, p=0.03), hypoglycemic symptom scores increased (18.8±6.3 to 27.3±12.7, p=0.02), epinephrine responses did not change (p=0.2). Post-intervention, hypoglycemia induced greater increases in ACC CBF (p=0.01, peak voxel coordinates [6,40,-2]), while thalamic and OFC activity did not change.</p> <p> </p> <p>Conclusions</p> <p>Increased blood flow is seen within brain pathways involved in internal self-awareness and decision-making (ACC) after restoration of hypoglycemia awareness, suggesting partial recovery of brain responses lost in IAH. Resistance of frontothalamic networks, involved in arousal and emotion processing, may explain why not all IAH individuals achieve awareness restoration with education and technology alone. </p>

Impaired awareness of hypoglycemia in adults with type 1 diabetes is not associated with peripheral neuropathy

2017 ◽  
Vol 12 (S 01) ◽  
pp. S1-S84
Author(s):  
D Tsitlakidis ◽  
M Djordjevic ◽  
N Müller ◽  
UA Müller ◽  
C Kloos
Keyword(s):  
Type 1 Diabetes ◽  
Peripheral Neuropathy ◽  
Impaired Awareness

Peculiarities of microcirculation in periodont tissues in children of key age groups sufficient type 1 diabetes. Part II

2019 ◽  
Vol 24 (2) ◽  
pp. 108-119 ◽  
Author(s):  
B. N. Davydov ◽  
D. A. Domenyuk ◽  
S. V. Dmitrienko
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Laser Doppler Flowmetry ◽  
Laser Doppler ◽  
Diabetic Microangiopathy ◽  
Healthy Children ◽  
Doppler Flowmetry

Relevance. Morpho-functional changes in peripheral circulation established in type 1 diabetes mellitus correlate with changes in central hemodynamics, allowing the use of microcirculation indicators as diagnostic and prognostic criteria for assessing the degree of functional vascular disorders. Identifcation of microcirculation features of the blood by the method of laser Doppler flowmetry in children with different experience of type 1 diabetes in key age categories.Materials and methods. The study included 67 children with type 1 diabetes mellitus aged 12-15 years with an experience of the disease from six months to ten years. The comparison group consisted of 38 healthy children. The state of the microvasculature was assessed by laser Doppler flowmetry using a laser analyzer for capillary blood flow LAKK-OP.Results. In children with an experience of type 1 diabetes of less than two years, microcirculation disorders in periodontal tissues correspond to the hyperemic form, accompanied by increased perfusion, a decrease in the amplitude of low-frequency oscillations, increased heart rate, high blood flling, and blood flow bypass. For children with an endocrinopathy experience of more than three years, microcirculation disorders correspond to a stagnant form, combined with a decrease in perfusion due to stagnation of blood in the venular link, endothelial domination with suppression of neurogenic and cardiac fluctuations, low efciency and redistribution of blood flow in favor of the nutritive link.Conclusions. With the increase in experience, the degree of compensation of type 1 diabetes, the progression of diabetic microangiopathy, it is advisable to designate two stages of development of microcirculatory disorders. Early – compensatory with active adaptation, including neurogenic and endothelial regulation mechanisms. Late – decompensation with passive adaptation, supporting the effectiveness of microcirculation due to myogenic control of regulation, shunting and increasing the rate of blood outflow.

scholarly journals Predictors of Recurrent Severe Hypoglycemia in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia During the HypoCOMPaSS Study

Diabetes Care ◽  
2019 ◽  
Vol 43 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Anneliese J.S. Flatt ◽  
Stuart A. Little ◽  
Jane Speight ◽  
Lalantha Leelarathna ◽  
Emma Walkinshaw ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Severe Hypoglycemia ◽  
Impaired Awareness

Interactive Diary for Diabetes: A Useful and Easy-to-Use New Telemedicine System to Support the Decision-Making Process in Type 1 Diabetes

2009 ◽  
Vol 11 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Maria C.E. Rossi ◽  
Antonio Nicolucci ◽  
Fabio Pellegrini ◽  
Daniela Bruttomesso ◽  
Paolo Di Bartolo ◽  
...  
Keyword(s):  
Decision Making ◽  
Type 1 Diabetes ◽  
Decision Making Process ◽  
Telemedicine System

Proposed Mechanisms of Blood Flow Restriction Exercise for the Improvement of Type 1 Diabetes Pathologies

Diabetology ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 176-189
Author(s):  
Morgan T. Jones ◽  
Elroy J. Aguiar ◽  
Lee J. Winchester
Keyword(s):  
Blood Flow ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Resistance Exercise ◽  
American Diabetes Association ◽  
Blood Flow Restriction ◽  
Clinical Population ◽  
Muscular System ◽  
Flow Restriction

Individuals with type 1 diabetes suffer from impaired angiogenesis, decreased capillarization, and higher fatigability that influence their muscular system beyond the detriments caused by decreased glycemic control. In order to combat exacerbations of these effects, the American Diabetes Association recommends that individuals with type 1 diabetes participate in regular resistance exercise. However, traditional resistance exercise only induces hypertrophy when loads of ≥65% of an individual’s one repetition maximum are used. Combining blood flow restriction with resistance exercise may serve as a more efficient means for stimulating anabolic pathways that result in increased protein synthesis and angiogenesis at lower loads, while also promoting better glycemic control. The purpose of this paper is to provide a review on the literature surrounding the benefits of resistance exercise, specifically for individuals with type 1 diabetes, and postulate potential effects of combining resistance exercise with blood flow restriction in this clinical population.

scholarly journals Evaluation of Hypoglycaemia with Non-Invasive Sensors in People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Ole Elvebakk ◽  
Christian Tronstad ◽  
Kåre I. Birkeland ◽  
Trond G. Jenssen ◽  
Marit R. Bjørgaas ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Non Invasive ◽  
Impaired Awareness Of Hypoglycaemia ◽  
Impaired Awareness
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