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

VL - 10

SP - 216

EP - 229

JO - Journal of the Renin-Angiotensin-Aldosterone System

JF - Journal of the Renin-Angiotensin-Aldosterone System

SN - 1470-3203

IS - 4

ER -