Cognitive and psychomotor function during severe insulin-induced hypoglycaemia in insulin-dependent diabetic patients.
Cognitive and psychomotor function, hormonal counterregulation and symptom awareness during severe insulin-induced hypoglycaemia were evaluated in 10 insulin-dependent diabetic patients. The glucose-clamp technique (Biostator) was applied to achieve a stable hypoglycaemic (39 +/- 2 mg/dl) plateau. A battery of 7 neuropsychological tests and a standardized questionnaire assessing hypoglycaemia symptoms were administered during euglycaemia and hypoglycaemia. There was a significant increase in counterregulatory hormone response (cortisol, growth hormone, p less than 0.05). Every patient experienced symptoms during severe hypoglycaemia. Four patients, however, were not aware of this threatening metabolic state. There was a significant performance decrement in all but two neuropsychological tests (Aiming Center I, Aiming Center II, Line Tracing Errors, Reaction Time, p less than 0.01; Digit Symbol, p less than 0.05). Performance of simple motor tasks as well as cognitive tasks requiring complex discrimination deteriorated similarly. Furthermore, the patients' general well-being (subjective condition) worsened considerably. In conclusion, a significant impairment of neuropsychological functions emerged during severe hypoglycaemia in insulin-dependent diabetes mellitus, even in the face of adequate hormonal counterregulation, and did not always coincide with an appropriate patient awareness of the actual metabolic state.
Lingenfelser
T
T
Department of Medicine, Eberhard-Karls University, Tübingen, FRG.
Overkamp
D
D
Renn
W
W
Hamster
W
W
Boughey
J
J
Eggstein
M
M
Jakober
B
B
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003071:Cognition / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000523:psychology*; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology
D001786:Blood Glucose; D007328:Insulin