Symptoms of Hypoglycaemia and Effects on Mental Performance and Emotions

Hypoglycaemia in Clinical Diabetes: Third Edition

Volumn , Issue , 2014, Pages 23-45

  Deary, Ian J ^a   Zammitt, Nicola N ^b  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

^b ROYAL INFIRMARY OF EDINBURGH   (United Kingdom)

Author keywords

Blood glucose concentration symptom report correlations; Hypoglycaemia symptoms; Interpreting hypoglycaemia symptoms correctly; Low blood glucose detection; Neuroglycopenic symptoms

Indexed keywords

EID: 84986918142     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1002/9781118695432.ch2     Document Type: Chapter

References (87)

1. Amiel, S.A., Pottinger, R.C., Archibald, H.R. et al. (1991) Effect of antecedent glucose control on cerebral function during hypoglycemia. Diabetes Care, 14, 109-118.
2. Blackman, J.D., Towle, V.L., Sturis, J., Lewis, G.F., Spire, J.-P. & Polonsky, K.S. (1992) Hypoglycemic thresholds for cognitive dysfunction in IDDM. Diabetes, 41, 392-399.
3. Bremer, J.P., Baron, M., Peters, H. et al. (2006) Hormonal, subjective and neurocognitive responses to brief hypoglycemia in postmenopausal women and age-matched men with type 2 diabetes mellitus. Metabolism: Clinical and Experimental, 55, 331-338.
4. Clarke, W.L., Cox, D.J., Gonder-Frederick, L.A., Julian, D., Schlundt, D. & Polonsky, W. (1997) The relationship between nonroutine use of insulin, food, and exercise and the occurrence of hypoglycemia in adults with IDDM and varying degrees of hypoglycemia awareness and metabolic control. Diabetes Education, 23, 55-58.
5. Cox, D.J., Clarke, W.L., Gonder-Frederick, L. et al. (1985) Accuracy of perceiving blood glucose in IDDM. Diabetes Care, 8, 529-536.
6. Cox, D.J., Irvine, A., Gonder-Frederick, L., Nowacek, G. & Butterfield, J. (1987) Fear of hypoglycemia: quantification, validation and utilization. Diabetes Care, 10, 617-621.
7. Cox, D.J., Gonder-Frederick, L., Antoun, B., Cryer, P.E. & Clarke, W.L. (1993a) Perceived symptoms in the recognition of hypoglycemia. Diabetes Care, 16, 519-527.
8. Cox, D.J., Gonder-Frederick, L. & Clarke, W. (1993b) Driving decrements in type 1 diabetes during moderate hypoglycemia. Diabetes, 42, 239-243.
9. Cox, D.J., Gonder-Frederick, L.A., Kovatchev, B.P., Julian, D.M. & Clarke, W.L. (2000) Progressive hypoglycemia's impact on driving simulation performance. Occurrence, awareness and correction. Diabetes Care, 23, 163-170.
10. Cox, D.J., Gonder-Frederick, L., Polonsky, W., Schlundt, D., Kovatchev, B. & Clarke, W. (2001) Blood glucose awareness training (BGAT-2): long-term benefits. Diabetes Care, 24, 637-642.
11. Cox, D.L., Kovatchev, B., Koev, D. et al. (2004) Hypoglycemia anticipation, awareness and treatment training (HAAT) reduces occurrence of severe hypoglycemia among adults with type 1 diabetes. International Journal of Behavioral Medicine, 11, 212-218.
12. Cox, D.J., Kovatchev, B.P., Anderson, S.M., Clarke, W.L. & Gonder-Frederick, L.A. (2010) Type 1 diabetic drivers with and without a history of recurrent hypoglycemia-related driving mishaps. Physiological and performance differences during euglycemia and the induction of hypoglycemia. Diabetes Care, 33, 2430-2435.
13. Deary, I.J. (1998) The effects of diabetes on cognitive function. Diabetes Annual, 11, 97-118.
14. Deary, I.J., Hepburn, D.A., MacLeod, K.M. & Frier, B.M. (1993) Partitioning the symptoms of hypogly- caemia using multi-sample confirmatory factor analysis. Diabetologia, 36, 771-777.
15. Deary, I.J., Sommerfield, A.J., McAulay, V. & Frier, B.M. (2003) Moderate hypoglycaemia obliterates working memory in humans with and without insulin treated diabetes. Journal of Neurology, Neurosurgery, and Psychiatry, 74, 277-282.
16. Debrah, T., Sherwin, R.S., Murphy, J. & Kerr, D. (1996) Effect of caffeine on recognition of and physiological responses to hypoglycaemia in insulin-dependent diabetes. Lancet, 347, 19-24.
17. Draelos, M.T., Jacobson, A.M., Weinger, K. et al. (1995) Cognitive function in patients with insulin- dependent diabetes mellitus during hyperglycemia and hypoglycemia. The American Journal of Medicine, 98, 135-144.
18. Driesen, N.R., Cox, D.J., Gonder-Frederick, L. & Clarke, W. (1995) Reaction time impairment in insulin- dependent diabetes: task complexity, blood glucose levels, and individual differences. Neuropsychology, 9, 246-254.
19. Evans, M.L., Pernet, A., Lomas, J., Jones, J. & Amiel, S.A. (2000) Delay in onset of awareness of acute hypoglycemia and of restoration of cognitive performance during recovery. Diabetes Care, 23, 893-897.
20. Ewing, F.M.E., Deary, I.J., McCrimmon, R.J., Strachan, M.W.J. & Frier, B.M. (1998) Effect of acute hypoglycemia on visual information processing in adults with type 1 diabetes mellitus. Physiology and Behavior, 64, 653-660.
21. Fletcher, A.A. & Campbell, W.R. (1922) The blood sugar following insulin administration and the symptom complex-hypoglycemia. Journal of Metabolic Research, 2, 637-649.
22. Geddes, J., Warren, R.E., Sommerfield, A.J. et al. (2006) Absence of sexual dimorphism in the symptomatic responses to hypoglycemia in adults with and without type 1 diabetes. Diabetes Care, 29, 1667-1669.
23. Geddes, J., Deary, I.J. & Frier, B.M. (2008) Effects of acute insulin-induced hypoglycaemia on psychomotor function: people with type 1 diabetes are less affected than non-diabetic adults. Diabetologia, 51, 1814-1821.
24. Geddes, J., Ratcliff, R., Allerhand, M. et al. (2010) Modeling the effects of hypoglycemia on a two-choice task in adult humans. Neuropsychology, 24, 652-660.
25. Gold, A.E., Deary, I.J., MacLeod, K.M. & Frier, B.M. (1995a) The effect of IQ level on the degree of cognitive deterioration experienced during acute hypoglycemia in normal humans. Intelligence, 20, 267-290.
26. Gold, A.E., MacLeod, K.M., Deary, I.J. & Frier, B.M. (1995b) Hypoglycemia-induced cognitive dysfunction in diabetes mellitus: effect of hypoglycemia unawareness. Physiology and Behavior, 58, 501-511.
27. Gold, A.E., MacLeod, K.M., Frier, B.M. & Deary, I.J. (1995c) Changes in mood during acute hypoglycemia in healthy subjects. Journal of Personality and Social Psychology, 68, 498-504.
28. Gold, A.E., Deary, I.J. & Frier, B.M. (1997a) Hypoglycaemia and non-cognitive aspects of psychological function in insulin-dependent (type 1) diabetes mellitus (IDDM). Diabetic Medicine, 14, 111-118.
29. Gold, A.E., Frier, B.M., MacLeod, K.M. & Deary, I.J. (1997b) A structural equation model for predictors of severe hypoglycaemia in patients with insulin-dependent diabetes mellitus. Diabetic Medicine, 14, 309-315.
30. Gonder-Frederick, L., Cox, D., Driesen, N.R., Ryan, C.M. & Clarke, W. (1994) Individual differences in neurobehavioral disruption during mild and moderate hypoglycemia in adults with IDDM. Diabetes, 43, 1407-1412.
31. Gonder-Frederick, L., Cox, D., Kovatchev, B., Schlundt, D. & Clarke, W. (1997) A biopsychobehavioral model of risk of severe hypoglycemia. Diabetes Care, 20, 661-669.
32. Graveling, A.J., Deary, I.J., Frier, B.M. (In press, 2013). Acute hypoglycemia impairs executive cognitive function in adults with and without type 1 diabetes. Diabetes Care. DOI: 10.2337/Dc13-0194
33. Hardy, K.J., Scase, M.O., Foster, D.H. & Scarpello, J.H. (1995) Effect of short term changes in blood glucose on visual pathway function in insulin dependent diabetes. The British Journal of Ophthalmology, 79, 38-41.
34. Heller, S.R. & Macdonald, I.A. (1996) The measurement of cognitive function during acute hypoglycaemia: experimental limitations and their effects on the study of hypoglycaemia unawareness. Diabetic Medicine, 13, 607-615.
35. Henderson, J.N., Allen, K.V., Deary, I.J. & Frier, B.M. (2003) Hypoglycaemia in insulin-treated type 2 diabetes: frequency, symptoms and impaired awareness. Diabetic Medicine, 20, 1016-1021.
36. Hepburn, D.A. (1993) Symptoms of hypoglycaemia. In: B.M. Frier & M. Fisher (eds), Hypoglycaemia and Diabetes: Clinical and Physiological Aspects, pp. 93-103. Edward Arnold, London.
37. Hepburn, D.A., Deary, I.J., Frier, B.M., Patrick, A.W., Quinn, J.D. & Fisher, M. (1991) Symptoms of acute insulin-induced hypoglycemia in humans with and without IDDM. Factor-analysis approach. Diabetes Care, 14, 949-957.
38. Hepburn, D.A., Deary, I.J., MacLeod, K.M. & Frier, B.M. (1994) Structural equation modeling of symptoms, awareness and fear of hypoglycemia, and personality in patients with insulin-treated diabetes. Diabetes Care, 17, 1273-1280.
39. Hermanns, N., Kubiak, T., Kulzer, B. & Haak, T. (2003) Emotional changes during experimentally-induced hypoglycaemia in type 1 diabetes. Biological Psychology, 63, 15-44.
40. Hoffman, R.G., Speelman, D.J., Hinnen, D.A., Conley, K.L., Guthrie, R.A. & Knapp, R.K. (1989) Changes in cortical functioning with acute hypoglycemia and hyperglycemia in type 1 diabetes. Diabetes Care, 12, 193-197.
41. Holmes, C.S. (1987) Metabolic control and auditory information processing at altered glucose levels in insulin dependent diabetes. Brain and Cognition, 6, 161-174.
42. Inkster, B. & Frier, B.M. (2012) The effects of acute hypoglycaemia on cognitive function in type 1 diabetes. British Journal of Diabetes and Vascular Disease, 12, 221-226.
43. Irvine, A.A., Cox, D. & Gonder-Frederick, L. (1992) Fear of hypoglycemia: relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus. Health Psychology, 11, 135-138.
44. Jaap, A.J., Jones, G.C., McCrimmon, R.J., Deary, I.J. & Frier, B.M. (1998) Perceived symptoms of hypogly- caemia in elderly type 2 diabetic patients treated with insulin. Diabetic Medicine, 15, 398-401.
45. Jones, T.W., McCarthy, G., Tamborlane, W.V. et al. (1990) Mild hypoglycemia and impairment of brainstem and cortical evoked potentials in healthy subjects. Diabetes, 39, 1550-1555.
46. Lindgren, M., Eckert, B., Stenberg, G. & Agardh, C.-D. (1996) Restitution of neurophysiological functions, performance, and subjective symptoms after moderate insulin-induced hypoglycaemia in non-diabetic men. Diabetic Medicine, 13, 218-225.
47. Lobmann, R., Smid, H.G.O.M., Pottag, G., Wagner, K., Heinze, H.J. & Lehnert, H. (2000) Impairment and recovery of elementary cognitive function induced by hypoglycemia in type-1 diabetic patients and healthy controls. The Journal of Clinical Endocrinology and Metabolism, 85, 2758-2766.
48. Macfarlane, P.I. & Smith, C.S. (1988) Perceptions of hypoglycaemia in childhood diabetes mellitus: a questionnaire study. Practical Diabetes, 5, 56-58.
49. Macfarlane, P.I., Walters, M., Stutchfield, P. & Smith, C.S. (1989) A prospective study of symptomatic hypoglycaemia in childhood diabetes. Diabetic Medicine, 6, 627-630.
50. Maran, A., Lomas, J., Macdonald, I.A. & Amiel, S.A. (1995) Lack of preservation of higher brain function during hypoglycaemia in patients with intensively-treated IDDM. Diabetologia, 38, 1412-1418.
51. Massaro, D.W. (1993) Information processing models: microscopes of the mind. Annual Review of Psychology, 44, 383-425.
52. McAulay, V., Deary, I.J. & Frier, B.M. (2001a) Symptoms of hypoglycaemia in people with diabetes. Diabetic Medicine, 18, 690-705.
53. McAulay, V., Deary, I.J., Ferguson, S.C. & Frier, B.M. (2001b) Acute hypoglycemia in humans causes attentional dysfunction while nonverbal intelligence is preserved. Diabetes Care, 24, 1745-1750.
54. McAulay, V., Deary, I.J., Sommerfield, A.J. & Frier, B.M. (2005) Attentional functioning is impaired during acute hypoglycaemia in people with type 1 diabetes. Diabetic Medicine, 23, 26-31.
55. McCrimmon, R.J., Gold, A.E., Deary, I.J., Kelnar, C.J.H. & Frier, B.M. (1995) Symptoms of hypoglycemia in children with IDDM. Diabetes Care, 18, 858-861.
56. McCrimmon, R.J., Deary, I.J., Huntly, B.J.P., MacLeod, K.J. & Frier, B.M. (1996) Visual information processing during controlled hypoglycaemia in humans. Brain, 119, 1277-1287.
57. McCrimmon, R.J., Deary, I.J. & Frier, B.M. (1997) Auditory information processing during acute insulin induced hypoglycaemia in non-diabetic human subjects. Neuropsychologia, 35, 1547-1553.
58. McCrimmon, R.J., Deary, I.J. & Frier, B.M. (1999a) Appraisal of mood and personality during hypoglycaemia. Physiology and Behavior, 67, 27-33.
59. McCrimmon, R.J., Ewing, F.M.E., Frier, B.M. & Deary, I.J. (1999b) Anger-state during acute insulin- induced hypoglycaemia. Physiology and Behavior, 67, 35-39.
60. McCrimmon, R.J., Deary, I.J., Gold, A.E. et al. (2003) Symptoms reported during experimental hypoglycaemia: effect of method of induction of hypoglycaemia and of diabetes per se. Diabetic Medicine, 20, 507-509.
61. Merbis, M.A.E., Snoek, F.J., Kane, K. & Heine, R.J. (1996) Hypoglycaemia induces emotional disruption. Patient Education and Counseling, 29, 117-122.
62. Mutch, W.J. & Dingwall-Fordyee, I. (1985) Is it a hypo? Knowledge of symptoms of hypoglycaemia in elderly diabetic patients. Diabetic Medicine, 2, 54-56.
63. Pennebaker, J.W., Cox, D.J., Gonder-Frederick, L., Wunseh, M.G., Evans, W.S. & Pohl, S. (1981) Physical symptoms related to blood glucose in insulin-dependent diabetics. Psychosomatic Medicine, 43, 489-500.
64. Polonsky, W.H., Davis, C.L., Jacobson, A.M. & Anderson, B.J. (1992) Correlates of hypoglycemic fear in type 1 and type 2 diabetes mellitus. Health Psychology, 11, 199-202.
65. Pramming, S., Thorsteinsson, B., Theilgaard, A., Pinner, E.M. & Binder, C. (1986) Cognitive function during hypoglycaemia in type 1 diabetes mellitus. British Medical Journal, 292, 647-650.
66. Ross, L.A., McCrimmon, R.J., Frier, B.M., Kelnar, C.J.H. & Deary, I.J. (1998) Hypoglyeaemie symptoms reported by children with type 1 diabetes mellitus and by their parents. Diabetic Medicine, 15, 836-843.
67. Russell, P.N. & Rix-Trot, H.M. (1975) An exploratory study of some behavioural consequences of insulin induced hypoglycaemia. The New Zealand Medical Journal, 81, 337-340.
68. Ryan, C.M., Dulay, D., Suprasongsin, C. & Becker, D.J. (2002) Detection of symptoms by adolescents and young adults with type 1 diabetes during experimental induction of mild hypoglycemia: role of hormonal and psychological variables. Diabetes Care, 25, 852-858.
69. Schachinger, H., Hegar, K., Hermanns, N. et al. (2005) Randomized controlled clinical trial of Blood Glucose Awareness Training (BGAT Ill) in Switzerland and Germany. Journal of Behavioral Medicine, 28, 587-594.
70. Sommerfield, A.J., Deary, I.J., McAulay, V. & Frier, B.M. (2003a) Moderate hypoglycemia impairs multiple memory functions in healthy adults. Neuropsychology, 17, 125-132.
71. Sommerfield, A.J., Deary, I.J., McAulay, V. & Frier, B.M. (2003b) Short-term, delayed, and working memory are impaired during hypoglycemia in individuals with type 1 diabetes. Diabetes Care, 26, 390-396.
72. Strachan, M.W.J., Deary, I.J., Ewing, F.M.E., Ferguson, S.C., Young, M.J. & Frier, B.M. (2001) Acute hypoglycemia impairs the functioning of the central but not peripheral nervous system. Physiology & Behavior, 72, 83-92.
73. Strachan, M.W.J., Ewing, F.M.E., Frier, B.M., McCrimmon, R.J. & Deary, I.J. (2003) Effects of acute hypoglycaemia on auditory information processing in adults with type 1 diabetes. Diabetologia, 46, 97-105.
74. Tallroth, G., Lindgren, M., Stenberg, G., Rosen, I. & Agardh, C.-D. (1990) 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, 319-323.
75. Ter Braak, E.W.M.T., Appleman, A.M.M.E., van de Laak, M.E., Stolk, R.P., van Haeften, T.W. & Erkelens, D.W. (2000) Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia. Diabetes Care, 23, 1467-1471.
76. Towler, D.A., Havlin, C.E., Craft, S. & Cryer, P. (1993) Mechanism of awareness of hypoglycemia: perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes, 42, 1791-1798.
77. UK Hypoglycaemia Study Group (2007) Risks of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia, 50, 1140-1147.
78. Warren, R.E. & Frier, B.M. (2005) Hypoglycaemia and cognitive function. Diabetes, Obesity and Metabolism, 7, 493-503.
79. Warren, R.E., Zammitt, N.N., Deary, I.J. & Frier, B.M. (2007) The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes. Diabetologia, 50, 178-185.
80. Weinger, K., Jacobson, A.M., Draelos, M.T., Finkelstein, D.M. & Simonson, D.C. (1995) Blood glucose estimation and symptoms during hyperglycemia and hypoglycemia in patients with insulin-dependent diabetes mellitus. The American Journal of Medicine, 98, 22-31.
81. Wild, D., van Maltzahn, R., Brohan, E., Christensen, T., Clauson, P. & Gonder-Frederick, L. (2007) A critical review of the literature on fear of hypoglycaemia in diabetes: implications for diabetes management and patient education. Patient Education and Counselling, 26, 10-15.
82. Wilder, J. (1943) Psychological problems in hypoglycemia. The American Journal of Digestive Diseases, 10, 428-435.
83. Wirsen, A., Tallroth, G., Lindgren, M. & Agardh, C.-D. (1992) Neuropsychological performance differs between type 1 diabetic and normal men during insulin-induced hypoglycaemia. Diabetic Medicine, 9, 156-165.
84. Wright, R., Frier, B.M. & Deary, I.J. (2009) Effects of acute insulin-induced hypoglycemia on spatial abilities in adults with type 1 diabetes. Diabetes Care, 32, 1503-1506.
85. Zammitt, N., Warren, R.E., Deary, I.J. & Frier, B.M. (2008) Delayed recovery of cognitive function following hypoglycemia in adults with type 1 diabetes: effects of impaired awareness of hypoglycemia. Diabetes, 3, 732-736.
86. Zammitt, N.N., Streftaris, G., Gibson, G.J., Deary, I.J. & Frier, B.M. (2011) Modeling the consistency of hypoglycemic symptoms: high variability in diabetes. Diabetes Technology and Therapeutics, 13, 571-578.
87. Ziegler, D., Hubinger, A., Muhlen, H. & Gries, F.A. (1992) Effects of previous glycaemic control on the onset and magnitude of cognitive dysfunction during hypoglycaemia in type 1 (insulin-dependent) diabetic patients. Diabetologia, 35, 828-834.