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Brain Damage Type 1 Diabetes

Diabetic Encephalopathy

Diabetic Encephalopathy

Encephalopathy is defined as brain disease, damage or malfunction. It characteristically results in an altered mental state, sometimes accompanied by such physical manifestations as tremors or lack of coordination of limb movements. Oftentimes there are changes in personality as well. There are many, many causes for encephalopathy, and the cause is usually one of the more than 150 descriptors attached to the diagnosis. For instance, hepatic encephalopathy is damage to the brain caused by liver disease. Lyme encephalopathy is the result of advanced Lyme disease. Diabetic encephalopathy is the result of damage to the brain caused by diabetes. It can cause symptoms that range from mild memory issues to severe impairment, including dementia, seizures and coma. While diabetic encephalopathy may occur in patients with either type 1 diabetes or type 2 diabetes, the nature of the cognitive deficits tends to be different in each. Type 2 Diabetes and Encephalopathy The primary symptom of encephalopathy is diminished brain function. This can take many forms. Type 2 diabetes tends to be associated with an increased risk of Alzheimer's disease or other forms of dementia. A 2011 study of more than 1000 men and women over age 60, published in the journal Neurology, found that people with diabetes were twice as likely to develop Alzheimer's disease over fifteen years as those participants who did not have diabetes. They were also 1.75 times more likely to develop other forms of dementia than non-diabetics in the study. There is no specific answer as to why this is, but a lot of research is going on to determine the exact mechanisms. Some researchers say that insulin resistance may interfere with the body's ability to break down amyloid, a protein that contributes to the formation of br Continue reading >>

Diabetic Coma Recovery: What You Need To Know

Diabetic Coma Recovery: What You Need To Know

In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>

Diabetes And Depression

Diabetes And Depression

The impact of this widespread disease on the brain is often overlooked. The complications of uncontrolled diabetes are well recognized: nerve damage, kidney disease, blindness, and circulation problems that affect the extremities. The disease’s impact on the brain, however, is often overlooked. This oversight could spell trouble for millions of Americans who face the daily challenge of controlling their blood sugar. Get more news from "On the Brain" the Harvard Mahoney Neuroscience Institute newsletter An estimated 26 million Americans have diabetes, according to the American Diabetes Association. Another 79 million have prediabetes, a condition in which blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. A growing body of evidence suggests that the cognitive health of millions with the disease is as much at risk as are other body systems from the effects of out-of-control blood sugar. “Unlike for certain other diseases, scientists originally didn’t know where to look in the brain for the effects of diabetes,” said Gail Musen, an HMS assistant professor of psychiatry and assistant investigator in the Section on Clinical, Behavioral, and Outcomes Research at Joslin Diabetes Center. “We knew, theoretically, that because it affects so much else in the body, it also could affect the brain,” she said. Since Musen’s first study of diabetes and brain function nearly a decade ago, the scientific community has gained a greater understanding of how diabetes—primarily type 1 diabetes—affects brain function. Shrinking brain Musen’s 2006 study, reported in the journal Diabetes, was the first comprehensive study of density changes in the brain’s gray matter as a result of type 1 diabetes. Its findings suggested that persistent Continue reading >>

Diabetes Increases Brain Damage Caused By Severe Hypoglycemia

Diabetes Increases Brain Damage Caused By Severe Hypoglycemia

Go to: Insulin-induced severe hypoglycemia causes brain damage. The hypothesis to be tested was that diabetes portends to more extensive brain tissue damage following an episode of severe hypoglycemia. Nine-week-old male streptozotocin-diabetic (DIAB; n = 10) or vehicle-injected control (CONT; n = 7) Sprague-Dawley rats were subjected to hyperinsulinemic (0.2 U·kg−1·min−1) severe hypoglycemic (10–15 mg/dl) clamps while awake and unrestrained. Groups were precisely matched for depth and duration (1 h) of severe hypoglycemia (CONT 11 ± 0.5 and DIAB 12 ± 0.2 mg/dl, P = not significant). During severe hypoglycemia, an equal number of episodes of seizure-like activity were noted in both groups. One week later, histological analysis demonstrated extensive neuronal damage in regions of the hippocampus, especially in the dentate gyrus and CA1 regions and less so in the CA3 region (P < 0.05), although total hippocampal damage was not different between groups. However, in the cortex, DIAB rats had significantly (2.3-fold) more dead neurons than CONT rats (P < 0.05). There was a strong correlation between neuronal damage and the occurrence of seizure-like activity (r2 > 0.9). Separate studies conducted in groups of diabetic (n = 5) and nondiabetic (n = 5) rats not exposed to severe hypoglycemia showed no brain damage. In summary, under the conditions studied, severe hypoglycemia causes brain damage in the cortex and regions within the hippocampus, and the extent of damage is closely correlated to the presence of seizure-like activity in nonanesthetized rats. It is concluded that, in response to insulin-induced severe hypoglycemia, diabetes uniquely increases the vulnerability of specific brain areas to neuronal damage. Keywords: Fluoro-Jade, insulin, seizure, streptozoto Continue reading >>

How Type 1 Diabetes Affects The Brain

How Type 1 Diabetes Affects The Brain

The brain is an expensive organ to run: Most studies suggest that it requires up to 20 percent of the body’s total energy resources despite only taking up approximately 2 percent of its overall weight. Maintaining appropriate glucose levels—the proper amounts of the simple sugar that acts as the body’s main energy source—is key to keeping the brain running at its best. This can be difficult for people—especially children—who have type 1 diabetes mellitus (T1D), an auto-immune disorder that stops the body from producing insulin, the hormone that helps to break down what we eat into that vital glucose fuel. New research reported through a national consortium called the Diabetes Research in Children Network suggest that this can affect brain development in myriad ways, some of which could offer new insights into our understanding of how the brain compensates, over time, for chronic or degenerative disease. The effects of hyper- and hypoglycemia Last year, my daughter, Ella, was diagnosed with Type 1 diabetes at age 10. As we learned more about the disease, we were cautioned to look out for both hyperglycemia, or high blood glucose levels, as well as hypoglycemia, low blood glucose levels. High blood sugars result in symptoms like increased thirst, frequent urination, headache, and fatigue. If high glucose levels continue for a long time, there could be long-term damage to the kidneys, eyes, and nerves. Low blood sugars, on the other hand, can lead to shakiness, anxiety, confusion, dizziness, and muscle weakness—and if not treated immediately, seizures or unconsciousness. While there’s no “perfect” number for glucose levels, it is recommended that most children stay between 70 and 180 mg/dL, checking their blood sugar 4-6 times per day with a glucometer, Continue reading >>

Type 1 Diabetes And The Brain

Type 1 Diabetes And The Brain

Is the presence and development of microvascular disease in type 1 diabetes related to changes in brain structure and cognitive function? 2006-.... Funding: Dutch Diabetes research Foundation. Contact person: Eelco van Duinkerken There is growing evidence that individuals with type 1 diabetes (DM1) have mild performance deficits in a range of neuropsychological tests compared to non-diabetic controls, but the mechanisms underlying cognitive deterioration in diabetes are still not fully understood. In the past decades, several studies have addressed the effects of recurrent hypoglycemia on cognition. While retrospective studies in adult patients with DM1 have demonstrated an association between a history of recurrent severe hypoglycemia and a modest degree of cognitive impairment, two large prospective studies did not find such an association. Reanalysis of the DCCT findings confirmed this conclusion. In contrast, there is evidence emerging for a damaging effect of chronic hyperglycemia on brain function. Hyperglycemia may lead to accumulation of potentially toxic glucose metabolites, oxidative stress, accelerated formation of advanced glycation end products and microvascular changes in the brain, analogous to peripheral complications of diabetes. Results of studies using Magnetic Resonance Imaging of the brain (MRI), concerning the severity of cerebral atrophy and white matter lesions in patients with DM1, are inconsistent. Problems with study design, including lack of appropriate controls, small sample sizes, and insensitive rating methods, are likely to contribute to these apparent inconsistencies. It is of great importance to determine whether the observed structural changes in the brain are related to cognition and to assess whether these are associated with disease Continue reading >>

Long-term Effects Of Diabetes Type One

Long-term Effects Of Diabetes Type One

Diabetes, whether type 1 or type 2, can contribute to the development of several serious long-term health problems. People with type 1 diabetes mellitus (T1DM) no longer make insulin, a hormone necessary to move glucose, or sugar, from the blood into the body cells to be used or stored as energy. Insulin is necessary to sustain life, so people with T1DM require replacement insulin to manage blood sugar levels. Over time, if blood sugar levels run too high, damage to blood vessels and nerves can occur, and this can cause health problems such as heart and blood vessel disease, kidney disease, nerve damage, eye disease and an increased risk of amputation. However, if blood sugars are kept to near-normal levels, these health problems can be minimized or prevented. Video of the Day According to an October 2013 review published in “Cardiovascular Diabetology," the risk of cardiovascular disease (CVD) in T1DM is 2 to 3 times higher in men and 3 to 5 times higher in women compared to people without diabetes. CVD, the leading cause of death in adults with T1DM, affects the large blood vessels that transport blood throughout the body, including to the heart, arms, legs and brain. Over time, high blood sugars can contribute to an impaired or blocked blood supply to the heart or brain, increasing the risk of heart attack or stroke. Poor blood flow may also lead to slower healing of wounds and serious infections in the limbs -- which in some cases may require amputation of the affected toes, feet or legs. High blood sugars contribute to the development of neuropathy, or nerve damage. An article published in the October 2008 issue of “Pharmacology & Therapeutics” reports that more than half of those with longstanding diabetes have some type of neuropathy. Diabetes peripheral ne Continue reading >>

Repeated Hypoglycemia Is Not Directly Linked To Brain Damage

Repeated Hypoglycemia Is Not Directly Linked To Brain Damage

Contrary to popular belief, repeated low blood sugar episodes do not appear to cause brain damage. That’s according to Dr. Alan M. Jacobson, a psychiatrist who is one of the world’s foremost experts on the relationship between diabetes and cognitive function. Jacobson is Director of the Diabetes, Obesity and Cardiometabolic Research Center at Winthrop-University Hospital and served as Director, Psychiatric Services at the Joslin Diabetes Center for more than 30 years. “We studied this intently and what we found was that hypoglycemia did not appear to confer an additional risk to reduced brain function,” Jacobson says. Jacobson was involved in the most comprehensive long-term study of whether hypoglycemia adversely impacts brain function. As part of a team Jacobson studied the effects of improved blood sugar control on type 1 diabetic patients who were participants in The Diabetes Control and Complications Trial—or DCCT. The DCCT tracked 1,441 type 1 diabetic patients ages 13 to 39 for six years to determine whether tighter blood sugar near the normal, non-diabetic range helped them avoid complications from diabetes, such as retinopathy and kidney disease. The landmark study demonstrated definitively that improved blood sugar control leads to a reduction in the incidence of diabetic complications. It also revealed something else. “Tightening control also leads to an increase in hypoglycemic events,” Jacobson says. “We found a three-fold increase in the number of serious hypoglycemic event in the subjects who had improved blood sugar control.” This increase in low blood sugar episodes prompted DCCT researchers to gauge whether their number and severity impacted cognitive function. The subjects performed intensive neuropsychological tests over the course Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Patients With Type 1 Diabetes Exhibit Altered Cerebral Metabolism During Hypoglycemia

Patients With Type 1 Diabetes Exhibit Altered Cerebral Metabolism During Hypoglycemia

Patients with type 1 diabetes mellitus (T1DM) experience on average 2 hypoglycemic episodes per week and 1 severe episode of hypoglycemia each year (1). Because the brain depends almost exclusively on glucose, recurrent hypoglycemia may be a threat for cognitive dysfunction and cerebral damage. Patients with T1DM are at increased risk for accelerated cognitive decline and possibly for dementia (2, 3). Interestingly, however, patients with T1DM enduring recurrent episodes of severe hypoglycemia do not appear at greater risk of developing cognitive function impairment than patients without such a history (4). This suggests that recurrent hypoglycemia can induce protective adaptations with respect to cerebral glucose metabolism or that hyperglycemia is at least as detrimental for the brain as hypoglycemia. Recently, we showed that brain glucose metabolism in healthy subjects at glucose levels of approximately 3 mmol/l did not differ from that at normal glucose levels, as reflected by similar tricarboxylic acid (TCA) cycle rates (VTCA) (5). This remarkable maintenance of normal VTCA during symptomatic hypoglycemia indicates that the glucose threshold for effects on cerebral metabolism lies below 3 mmol/l, either because the brain can endure low glucose levels or because entrance of nonglucose energy substrates such as lactate compensates for the fall in glucose (6–9). Whether these findings can be extrapolated to patients with T1DM remains to be determined. This study was therefore undertaken to investigate the effect of hypoglycemia on brain glucose metabolism in a representative group of patients with longstanding, uncomplicated, reasonably well-controlled T1DM. To do so, we used 13C magnetic resonance spectroscopy (MRS) of the human brain during euglycemic and hypoglyc Continue reading >>

What Is Type 1 Diabetes?

What Is Type 1 Diabetes?

Type 1 diabetes may also be known by a variety of other names, including the following: Insulin-dependent diabetes mellitus (IDDM) Juvenile diabetes Brittle diabetes Sugar diabetes There are two forms of type 1 diabetes: Idiopathic type 1 diabetes. This refers to rare forms of the disease with no known cause. Immune-mediated diabetes. An autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. Immune-mediated diabetes is the most common form of type 1 diabetes, and the one generally referred to as type 1 diabetes. The information on this page refers to this form of type 1 diabetes. Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes in the U.S. Type 1 diabetes usually develops in children or young adults, but can start at any age. What causes type 1 diabetes? The cause of type 1 diabetes is unknown, but it is believed that genetic and environmental factors (possibly viruses) may be involved. The body's immune system attacks and destroys the insulin producing cells in the pancreas. Insulin allows glucose to enter the cells of the body to provide energy. When glucose cannot enter the cells, it builds up in the blood, depriving the cells of nutrition. People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels. What are the symptoms of type 1 diabetes? Type 1 diabetes often appears suddenly. The following are the most common symptoms of type 1 diabetes. However, each individual may experience symptoms differently. Symptoms may include: High levels of sugar in the blood when tested High levels of sugar in the urine when tested Unusual thirst Frequent urination Extreme hunger Unexplained weight loss Blurred vision Nausea Continue reading >>

Type 1 Diabetes Diagnosis May Come With Brain Changes In Kids, Including Memory Loss

Type 1 Diabetes Diagnosis May Come With Brain Changes In Kids, Including Memory Loss

Diabetes is the seventh leading cause of the death in the United States. A new study reveals another disturbing detail. Researchers found that type 1 diabetes in children can cause brain loss, affecting memory and attention cognition. Diabetic ketoacidosis (DKA) is a harmful complication of Type 1 Diabetes that can gradually alter brain matter in newly diagnosed children. "Children and adolescents diagnosed with type 1 diabetes with diabetic ketoacidosis have evidence of brain gray matter shrinkage and white matter swelling," the study's lead author Dr. Fergus Cameron, head of diabetes services at Royal Children's Hospital in Victoria, Australia, told HealthDay. The recent study includes 36 children and teens with DKA and 59 without it. MRIs were taken over the course of six months. Those with DKA experienced a decrease in gray matter volume along with swelling of white matter. There was also evidence of memory loss and reduced sustained and divided attention. Symptoms tended to develop over time, raising a big concern for parents who might not notice any differences in their child right away. "Any decrement in attention or memory in children is a concern as children are acquiring new knowledge and learning new skills all the time," Cameron said. Cameron and his team found that 20 to 30 percent of children newly diagnosed with type 1 diabetes had DKA. According to the CDC, from 2002 to 2003, 15,000 youth in the United States were newly diagnosed with type 1 diabetes each year. "DKA still kills people, so we need to do better. We need better tools. And we need to educate doctors more on the symptoms of type 1 diabetes," Cameron said. The Juvenile Diabetes Research Foundation reports that type 1 diabetes is on the rise. Each year, 30,000 U.S. adults and children are diagn Continue reading >>

Diabetic Emergencies: Hypoglycemia Caused By Insulin, Part 3

Diabetic Emergencies: Hypoglycemia Caused By Insulin, Part 3

Consequences of acute hypoglycemia Acute hypoglycemia can lead to health damage either directly (from deleterious effects of low blood glucose supply to the brain) or indirectly, usually via trauma due to loss of consciousness or seizures. As an example, hypoglycemia may occur during driving and may obviously cause road traffic accidents…. In the vast majority of cases, recovery from a severe hypoglycemic event, even if it manifests with seizures or coma, is complete. Sometimes, neurologic abnormalities can be observed immediately after recovery of consciousness and improve afterwards. Hypoglycemic hemiplegia is an uncommon condition that has been described as a hemiparetic state, presenting in the morning when the patient awakens after a nocturnal hypoglycemic event. The episode typically resolves after a few minutes or hours and may recur. 28 Permanent neurologic damage and death have been reported rarely, 29 especially after massive insulin overdose and delayed restoration of normoglycemia. 30 Another possible mechanism of acute health damage, including sudden death, due to hypoglycemia is via the induction of cardiovascular events. Hypoglycemia has been implicated in the so-called "dead-in-bed syndrome," the unexpected death of a young person with Type 1 diabetes found dead in an undisturbed bed. 29 It has also been suggested that the increased total mortality risk observed in the intensive glycemic control arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study might be due to the high rate of hypoglycemic events. 18 However, this insinuation has not been verified in post hoc analysis of the trial data. 31 It has been shown that hypoglycemia, especially in patients with pre-existing cardiovascular disease, induces multiple proarrhythmic change Continue reading >>

Diabetic Encephalopathy

Diabetic Encephalopathy

Diabetic encephalopathy is damage to the brain caused by diabetes. A relatively unknown complication, encephalopathy is becoming more widely recognized as more people are diagnosed with type 1 and type 2 diabetes. Diabetic encephalopathy presents itself both mentally and physically. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses, or severe impairment like dementia. The complication can also cause tremors, lack of coordination, and even seizures. Diabetic encephalopathy is largely due to acute hypoglycemia (blood sugar levels are too low) or severe hyperglycemia (blood sugar levels are too high). The condition manifests itself differently between the two major types of diabetes. Type 2 diabetes Encephalopathy in those with type 2 diabetes increases the risk of developing Alzheimer’s disease or other forms of dementia. According to a 2011 study, those with type 2 diabetes were twice as likely to develop Alzheimer’s and 1.75 times more likely to develop other forms of dementia than healthy participants. This increased risk could be due to many different factors brought about from type 2 diabetes. It could be caused by the body’s resistance to insulin, which makes it difficult for the brain to break down amyloid, a protein that forms brain plaques. Brain plaques are abnormal clusters of this protein that block cell-to-cell signaling at the synapses—a symptom infamous for contributing to the development of Alzheimer’s disease. Type 2 diabetic encephalopathy can also be generated from hyperglycemia or the conditions that commonly accompany type 2 diabetes like high blood pressure, obesity, or high cholesterol. Oxidative stress is another provoker of the complication. This stems from an imbalance between reactive oxyge Continue reading >>

The Final Frontier: How Does Diabetes Affect The Brain?

The Final Frontier: How Does Diabetes Affect The Brain?

Our understanding of the impact of diabetes on organ function has been evolving since the discovery of insulin in the 1920s. At that time insulin was a miracle drug that appeared to cure diabetes, but over time it became clear that death and disability from diabetes complications involving the eyes, kidneys, peripheral nerves, heart, and vasculature could occur even with treatment. With the improvement in diabetes care over the past 20 years, fewer patients are developing the traditional diabetes complications. However, as people live long and well with the disease, it has become apparent that diabetes can alter function and structure in tissues not typically associated with complications such as the brain and bone. Alteration in brain structure and function are particularly of concern because of the impact of dementia and cognitive dysfunction on overall quality of life. From large epidemiological studies, it has been demonstrated that both vascular and Alzheimer's dementia are more common in patients with type 2 diabetes (1). Why this might be true has been difficult to define. Certainly these patients can be expected to have more risk factors such as previous cardiovascular disease, history of hypertension, and dyslipidemia than aged matched control subjects, but when these variables are controlled, the risk for patients with diabetes appears to be higher than that of other subject groups. Persistent hyperglycemia appears to play an important role in cerebral dysfunction. Many years ago, Reaven et al. (2) demonstrated that performance on cognitive tasks assessing learning, reasoning, and complex psychomotor performance was inversely related to glycemic control in a small population of subjects with type 2 diabetes. This issue was recently readdressed in the much larg Continue reading >>

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