Is hypoglycaemia dangerous?

Best Practice and Research: Clinical Anaesthesiology

Volumn 23, Issue 4, 2009, Pages 473-485

  Duning, Thomas ^a   Ellger, Björn ^a  

^a UNIVERSITY HOSPITAL MÜNSTER   (Germany)

Author keywords

hypoglycaemia; ICU; neurocognitive function; tight glycaemic control

Indexed keywords

ACETYLSALICYLIC ACID; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BICARBONATE; GLUCOSE; INSULIN; OCTREOTIDE; ORAL ANTIDIABETIC AGENT;

ACUTE DISEASE; ADDISON DISEASE; AUTOREGULATION; BRAIN BLOOD FLOW; BRAIN DAMAGE; BRAIN ISCHEMIA; BRAIN METABOLISM; CARDIOVASCULAR DISEASE; CENTRAL NERVOUS SYSTEM DISEASE; CLINICAL ASSESSMENT TOOL; CLINICAL FEATURE; CLINICAL TRIAL; COGNITIVE DEFECT; COMPUTER ASSISTED TOMOGRAPHY; CRITICALLY ILL PATIENT; DIABETES MELLITUS; DIABETOGENESIS; DISEASE COURSE; DISEASE PREDISPOSITION; DISEASE SEVERITY; EARLY INTERVENTION; GLUCONEOGENESIS; GLUCOSE BLOOD LEVEL; GLUCOSE BRAIN LEVEL; GLUCOSE TRANSPORT; GLYCEMIC CONTROL; HUMAN; HYPERGLYCEMIA; HYPOGLYCEMIA; INSULIN INFUSION; INSULIN RESISTANCE; INTENSIVE CARE; MORTALITY; NERVE CELL NECROSIS; NEUROENDOCRINE SYSTEM; NEUROLOGIC DISEASE; NUCLEAR MAGNETIC RESONANCE IMAGING; PATHOPHYSIOLOGY; PATIENT MONITORING; PRIORITY JOURNAL; PROGNOSIS; QUALITY OF LIFE; RECURRENT DISEASE; REVIEW;

ANIMALS; BLOOD GLUCOSE; COGNITION DISORDERS; CRITICAL ILLNESS; HUMANS; HYPOGLYCEMIA; INTENSIVE CARE UNITS; SEVERITY OF ILLNESS INDEX; TIME FACTORS;

EID: 70649095268     PISSN: 15216896     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.bpa.2009.09.002     Document Type: Review

References (100)

1. Cryer P.E. Hypoglycemia. Pathophysiology, diagnosis and treatment (1997), Oxford Univ. Press, New York
2. Nehlig A. Cerebral energy metabolism, glucose transport and blood flow: changes with maturation and adaptation to hypoglycaemia. Diabetes Metabolism 23 (1997) 18-29
3. Suh S.W., Hamby A.M., and Swanson R.A. Hypoglycemia, brain energetics, and hypoglycemic neuronal death. Glia 55 (2007) 1280-1286
4. Lewis L.D., Ljunggren B., Ratcheson R.A., et al. Cerebral energy state in insulin-induced hypoglycemia, related to blood glucose and to EEG. Journal of Neurochemistry 23 (1974) 673-679
5. Cornblath M., Hawdon J.M., Williams A.F., et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 105 (2000) 1141-1145
6. Alkalay A.L., Flores-Sarnat L., Sarnat H.B., et al. Plasma glucose concentrations in profound neonatal hypoglycemia. Clinical Pediatrics (Phila) 45 (2006) 550-558
7. Warren R.E., and Frier B.M. Hypoglycaemia and cognitive function. Diabetes, Obesity & Metabolism 7 (2005) 493-503
8. Frier B.M. Hypoglycaemia and cognitive function in diabetes. International Journal of Clinical Practice. Supplement (2001) 30-37
9. McAulay V., Deary I.J., and Frier B.M. Symptoms of hypoglycaemia in people with diabetes. Diabetes Medicine 18 (2001) 690-705
10. Towler D.A., Havlin C.E., Craft S., et al. Mechanism of awareness of hypoglycemia. Perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes 42 (1993) 1791-1798
11. Cryer P.E., Davis S.N., and Shamoon H. Hypoglycemia in diabetes. Diabetes Care 26 (2003) 1902-1912
12. Strachan M.W., Deary I.J., Ewing F.M., et al. Recovery of cognitive function and mood after severe hypoglycemia in adults with insulin-treated diabetes. Diabetes Care 23 (2000) 305-312
13. Frier B.M. Defining hypoglycaemia: what level has clinical relevance?. Diabetologia 52 (2009) 31-34
14. Boyle P.J., Nagy R.J., O'Connor A.M., et al. Adaptation in brain glucose uptake following recurrent hypoglycemia. Proceedings of the National Academy of Sciences of the United States of America 91 (1994) 9352-9356
15. Davis M.R., and Shamoon H. Counterregulatory adaptation to recurrent hypoglycemia in normal humans. The Journal of Clinical Endocrinology and Metabolism 73 (1991) 995-1001
16. Boyle P.J. Alteration in brain glucose metabolism induced by hypoglycaemia in man. Diabetologia 40 Suppl. 2 (1997) S69-S74
17. Heller S.R., and Macdonald I.A. The measurement of cognitive function during acute hypoglycaemia: experimental limitations and their effect on the study of hypoglycaemia unawareness. Diabetes Medicine 13 (1996) 607-615
18. Deary I.J. Effects of hypoglycaemia on cognitive function. In: Frier B.M., and Fisher B.M. (Eds). Hypoglycaemia and diabetes: clinical and physiological aspects. 2nd ed. (1993), Ewald Arnold, London 80-92
19. Holmes C.S., Hayford J.T., Gonzalez J.L., et al. A survey of cognitive functioning at difference glucose levels in diabetic persons. Diabetes Care 6 (1983) 180-185
20. McAulay V., Deary I.J., Ferguson S.C., et al. Acute hypoglycemia in humans causes attentional dysfunction while nonverbal intelligence is preserved. Diabetes Care 24 (2001) 1745-1750
21. Widom B., and Simonson D.C. Glycemic control and neuropsychologic function during hypoglycemia in patients with insulin-dependent diabetes mellitus. Annals of Internal Medicine 112 (1990) 904-912
22. Wirsen A., Tallroth G., Lindgren M., et al. Neuropsychological performance differs between type 1 diabetic and normal men during insulin-induced hypoglycaemia. Diabetes Medicine 9 (1992) 156-165
23. Cox D.J., Gonder-Frederick L.A., Schroeder D.B., et al. Disruptive effects of acute hypoglycemia on speed of cognitive and motor performance. Diabetes Care 16 (1993) 1391-1393
24. Deary I.J., Sommerfield A.J., McAulay V., et al. Moderate hypoglycaemia obliterates working memory in humans with and without insulin treated diabetes. Journal of Neurological Neurosurgery Psychiatry 74 (2003) 278-279
25. Pramming S., Thorsteinsson B., Theilgaard A., et al. Cognitive function during hypoglycaemia in type I diabetes mellitus. British Medical Journal (Clinical Research Edition) 292 (1986) 647-650
26. Gordon S.M., Jackson J.C., Ely E.W., et al. Clinical identification of cognitive impairment in ICU survivors: insights for intensivists. Intensive Care Medicine 30 (2004) 1997-2008
27. Hopkins R.O., and Brett S. Chronic neurocognitive effects of critical illness. Current Opinion of the Critical Care 11 (2005) 369-375
28. Mitrakou A., Ryan C., Veneman T., et al. Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. American Journal of Physiology 260 (1991) E67-E74
29. Boeve B.F., Bell D.G., and Noseworthy J.H. Bilateral temporal lobe MRI changes in uncomplicated hypoglycemic coma. Canadian Journal of Neurological Science 22 (1995) 56-58
30. Chalmers J., Risk M.T., Kean D.M., et al. Severe amnesia after hypoglycemia. Clinical, psychometric, and magnetic resonance imaging correlations. Diabetes Care 14 (1991) 922-925
31. Gold A.E., and Marshall S.M. Cortical blindness and cerebral infarction associated with severe hypoglycemia. Diabetes Care 19 (1996) 1001-1003
32. Lo L., Tan A.C., Umapathi T., et al. Diffusion-weighted MR imaging in early diagnosis and prognosis of hypoglycemia. AJNR American Journal of Neuroradiology 27 (2006) 1222-1224
33. McCall A.L. The impact of diabetes on the CNS. Diabetes 41 (1992) 557-570
34. Perros P., Sellar R.J., and Frier B.M. Chronic pontine dysfunction following insulin-induced hypoglycemia in an IDDM patient. Diabetes Care 17 (1994) 725-727
35. Fujioka M., Okuchi K., Hiramatsu K.I., et al. Specific changes in human brain after hypoglycemic injury. Stroke 28 (1997) 584-587
36. Cubo E., Andres M.T., Rojo A., et al. Neuroimaging of hypoglycemia. Revue Neurologique 26 (1998) 774-776
37. Garambois K., Grand S., Jaillard A., et al. Diffusion-weighted magnetic resonance imaging in hypoglycemic coma. Revue Neurologique 160 (2004) 575-578
38. Ho M.S., Weller N.J., Ives F.J., et al. Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus. Journal of Pediatrics 153 (2008) 385-390
39. Perantie D.C., Wu J., Koller J.M., et al. Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1 diabetes. Diabetes Care 30 (2007) 2331-2337
40. Kodl C.T., Franc D.T., Rao J.P., et al. Diffusion tensor imaging identifies deficits in white matter microstructure in subjects with type 1 diabetes that correlate with reduced neurocognitive function. Diabetes 57 (2008) 3083-3089
41. Warren R.E., Sommerfield A.J., Greve A., et al. Moderate hypoglycaemia after learning does not affect memory consolidation and brain activation during recognition in non-diabetic adults. Diabetes Metabolism Research Reviews 24 (2008) 247-252
42. Auer R.N., Wieloch T., Olsson Y., et al. The distribution of hypoglycemic brain damage. Acta Neuropathology 64 (1984) 177-191
43. Auer R.N., Olsson Y., and Siesjo B.K. Hypoglycemic brain injury in the rat. Correlation of density of brain damage with the EEG isoelectric time: a quantitative study. Diabetes 33 (1984) 1090-1098
44. Suh S.W., Aoyama K., Chen Y., et al. Hypoglycemic neuronal death and cognitive impairment are prevented by poly(ADP-ribose) polymerase inhibitors administered after hypoglycemia. Journal of Neuroscience 23 (2003) 10681-10690
45. Auer R.N., Hugh J., Cosgrove E., et al. Neuropathologic findings in three cases of profound hypoglycemia. Clinical Neuropathology 8 (1989) 63-68
46. Arky R.A., Veverbrants E., and Abramson E.A. Irreversible hypoglycemia. A complication of alcohol and insulin. Journal of American Medical Association 206 (1968) 575-578
47. Patrick A.W., and Campbell I.W. Fatal hypoglycaemia in insulin-treated diabetes mellitus: clinical features and neuropathological changes. Diabetes Medicine 7 (1990) 349-354
48. Swanson R.A., Ying W., and Kauppinen T.M. Astrocyte influences on ischemic neuronal death. Current Molecular Medicine 4 (2004) 193-205
49. McNay E.C., Williamson A., McCrimmon R.J., et al. Cognitive and neural hippocampal effects of long-term moderate recurrent hypoglycemia. Diabetes 55 (2006) 1088-1095
50. Yamada K.A., Rensing N., Izumi Y., et al. Repetitive hypoglycemia in young rats impairs hippocampal long-term potentiation. Pediatric Research 55 (2004) 372-379
51. Laitinen T., Lyyra-Laitinen T., Huopio H., et al. Electrocardiographic alterations during hyperinsulinemic hypoglycemia in healthy subjects. Annals of Noninvasive Electrocardiology 13 (2008) 97-105
52. Lindgren M., Eckert B., Stenberg G., et al. Restitution of neurophysiological functions, performance, and subjective symptoms after moderate insulin-induced hypoglycaemia in non-diabetic men. Diabetes Medicine 13 (1996) 218-225
53. Tallroth G., Lindgren M., Stenberg G., et al. Neurophysiological changes during insulin-induced hypoglycaemia and in the recovery period following glucose infusion in type 1 (insulin-dependent) diabetes mellitus and in normal man. Diabetologia 33 (1990) 319-323
54. Robinson A.M., Parkin H.M., Macdonald I.A., et al. Antecedent hypoglycaemia in non-diabetic subjects reduces the adrenaline response for 6 days but does not affect the catecholamine response to other stimuli. Clinical Science (London) 89 (1995) 359-366
55. Langan S.J., Deary I.J., Hepburn D.A., et al. Cumulative cognitive impairment following recurrent severe hypoglycaemia in adult patients with insulin-treated diabetes mellitus. Diabetologia 34 (1991) 337-344
56. Lincoln N.B., Faleiro R.M., Kelly C., et al. Effect of long-term glycemic control on cognitive function. Diabetes Care 19 (1996) 656-658
57. Effects of intensive diabetes therapy on neuropsychological function in adults in the Diabetes Control and Complications Trial. Annals of Internal Medicine 124 (1996) 379-388
58. Austin E.J., and Deary I.J. Effects of repeated hypoglycemia on cognitive function: a psychometrically validated reanalysis of the Diabetes Control and Complications Trial data. Diabetes Care 22 (1999) 1273-1277
59. Reichard P., and Pihl M. Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Diabetes 43 (1994) 313-317
60. Jacobson A.M., Musen G., Ryan C.M., et al. Long-term effect of diabetes and its treatment on cognitive function. New England Journal of Medicine 356 (2007) 1842-1852
61. Deary I.J., and Frier B.M. Severe hypoglycaemia and cognitive impairment in diabetes. British Medical Journal 313 (1996) 767-768
62. Soltesz G., and Acsadi G. Association between diabetes, severe hypoglycaemia, and electroencephalographic abnormalities. Archives of Diseases in Childhood 64 (1989) 992-996
63. MacLeod K.M., Hepburn D.A., Deary I.J., et al. Regional cerebral blood flow in IDDM patients: effects of diabetes and of recurrent severe hypoglycaemia. Diabetologia 37 (1994) 257-263
64. Dejgaard A., Gade A., Larsson H., et al. Evidence for diabetic encephalopathy. Diabetes Medicine 8 (1991) 162-167
65. Reske-Nielsen E., and Lundbaek K. Diabetic encephalopathy. Diffuse and focal lesions of the brain in long-term diabetes. Acta Neurologica Scandinavica. Supplementum 39 Suppl. (1963) 4-90
66. Mori F., Nishie M., Houzen H., et al. Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology 26 (2006) 147-152
67. Ko S.B., Bae H.J., Lee S.H., et al. Teaching NeuroImage: hippocampal involvement in a patient with hypoglycemic coma. Neurology 71 (2008) e63
68. Auer R.N. Hypoglycemic brain damage. Forensic Science International 146 (2004) 105-110
69. Bree A.J., Puente E.T., Daphna-Iken D., et al. Diabetes increases brain damage caused by severe hypoglycemia. American Journal of Physiology Endocrinology and Metabolism (2009)
70. Robinson R., Krishnakumar A., and Paulose C.S. Enhanced dopamine D1 and D2 receptor gene expression in the hippocampus of hypoglycaemic and diabetic rats. Cellular and Molecular Neurobiology 29 (2009) 365-372
71. Simpson I.A., Appel N.M., Hokari M., et al. Blood-brain barrier glucose transporter: effects of hypo- and hyperglycemia revisited. Journal of Neurochemistry 72 (1999) 238-247
72. Lecomte P., Foubert L., Nobels F., et al. Dynamic tight glycemic control during and after cardiac surgery is effective, feasible, and safe. Anesthesia and Analgesia 107 (2008) 51-58
73. Griesdale D.E., de Souza R.J., van Dam R.M., et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Canadian Medical Association Journal 180 (2009) 821-827
74. Krinsley J.S., and Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Critical Care Medicine 35 (2007) 2262-2267
75. Waeschle R.M., Moerer O., Hilgers R., et al. The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability. Critical Care 12 (2008) R129
76. Brunkhorst F.M., Engel C., Bloos F., et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. New England Journal of Medicine 358 (2008) 125-139
77. Krinsley J.S. The severity of sepsis: yet another factor influencing glycemic control. Critical Care 12 (2008) 194
78. Gill R.Q., and Sterling R.K. Acute liver failure. Journal of Clinical Gastroenterology 33 (2001) 191-198
79. Van den Bergh G., Wilmer A., Hermans G., et al. Intensive insulin therapy in the medical ICU. New England Journal of Medicine 354 (2006) 449-461
80. Weissenborn K., Bokemeyer M., Krause J., et al. Neurological and neuropsychiatric syndromes associated with liver disease. AIDS (London, England) 19 Suppl. 3 (2005) S93-S98
81. Vogelzang M., Loef B.G., Regtien J.G., et al. Computer-assisted glucose control in critically ill patients. Intensive Care Medicine 34 (2008) 1421-1427
82. Vriesendorp T.M., van Santen S., DeVries J.H., et al. Predisposing factors for hypoglycemia in the intensive care unit. Critical Care Medicine 34 (2006) 96-101
83. Smith W.D., Winterstein A.G., Johns T., et al. Causes of hyperglycemia and hypoglycemia in adult inpatients. American Journal of Health-System Pharmacy 62 (2005) 714-719
84. Henry L., Dunning E., Halpin L., et al. Nurses' perceptions of glycemic control in patients who have undergone cardiac surgery. Clinical Nurse Specialist 22 (2008) 271-277
85. Goldstein S.A., and Elwyn D.H. The effects of injury and sepsis on fuel utilization. Annual Review of Nutrition 9 (1989) 445-473
86. Adam-Perrot A., Clifton P., and Brouns F. Low-carbohydrate diets: nutritional and physiological aspects. Obesity Reviews 7 (2006) 49-58
87. Kagansky N., Levy S., Rimon E., et al. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Archives of Internal Medicine 163 (2003) 1825-1829
88. Van den B.G., Wilmer A., Milants I., et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes 55 (2006) 3151-3159
89. Vriesendorp T.M., DeVries J.H., van Santen S., et al. Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Critical Care Medicine 34 (2006) 2714-2718
90. Finfer S., Chittock D.R., Su S.Y., et al. Intensive versus conventional glucose control in critically ill patients. New England Journal of Medicine 360 (2009) 1283-1297
91. Krinsley J.S. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Critical Care Medicine 36 (2008) 3008-3013
92. Gunther M.L., Jackson J.C., and Ely E.W. Loss of IQ in the ICU brain injury without the insult. Medic Hypotheses 69 (2007) 1179-1182
93. Hopkins R.O., and Jackson J.C. Long-term neurocognitive function after critical illness. Chest 130 (2006) 869-878
94. Malone J.I., Hanna S., Saporta S., et al. Hyperglycemia not hypoglycemia alters neuronal dendrites and impairs spatial memory. Pediatrics Diabetes 9 (2008) 531-539
95. Suh S.W., Gum E.T., Hamby A.M., et al. Hypoglycemic neuronal death is triggered by glucose reperfusion and activation of neuronal NADPH oxidase. Journal of Clinical Investigation 117 (2007) 910-918
96. Tanaka Y., Takata T., Satomi T., et al. The double-edged effect of insulin on the neuronal cell death associated with hypoglycemia on the hippocampal slice culture. The Kobe Journal of Medical Science 54 (2008) E97-107
97. Gonder-Frederick L.A., Zrebiec J.F., Bauchowitz A.U., et al. Cognitive function is disrupted by both hypo- and hyperglycemia in school-aged children with type 1 diabetes: a field study. Diabetes Care 32 (2009) 1001-1006
98. Wessels A.M., Scheltens P., Barkhof F., et al. Hyperglycaemia as a determinant of cognitive decline in patients with type 1 diabetes. European Journal of Pharmacology 585 (2008) 88-96
99. Van den Berghe G., Schoonheydt K., Becx P., et al. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 64 (2005) 1348-1353
100. Eslami S., de Keizer N.F., de Jonge E., et al. A systematic review on quality indicators for tight glycaemic control in critically ill patients: need for an unambiguous indicator reference subset. Critical Care 12 (2008) R139