This Article Free Full Text (Free OnlineFirst PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Høi-Hansen, T. Articles by Thorsteinsson, B. PubMed PubMed Citation Articles by Høi-Hansen, T. Articles by Thorsteinsson, B. Social Bookmarking                         What's this?

Cognitive performance, symptoms and counter-regulation during hypoglycaemia in patients with type 1 diabetes and high or low renin-angiotensin system activity

¹ Endocrinology Section, Department of Cardiology, and Endocrinology, Hillerød Hospital, Hillerød, Denmark
² Department of Cardiology, and Endocrinology, Hillerød Hospital, Hillerød, Denmark
³ Department of Oral Pathology, Copenhagen Pathology, School of Dentistry, Copenhagen, Denmark
⁴ Department of Neurophysiology, Rigshospitalet, Copenhagen, Denmark
⁵ Department of Neurology, Rigshospitalet, Copenhagen, Denmark
⁶ Department of Biomedical Sciences, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
⁷ Centre for Healthy Ageing, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
⁸ Department of Internal Medicine, Erasmus MC, Rotterdam, Holland

^* To whom correspondence should be addressed. E-mail: pelk{at}hih.regionh.dk.

	Abstract

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.

First published on August 28, 2009
Journal of Renin-Angiotensin-Aldosterone System 2009, doi:10.1177/1470320309343007


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?