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

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Thomas Høi-Hansen, Ulrik Pedersen-Bjergaard, Rikke Due Andersen, Peter Lommer Kristensen, Carsten Thomsen, Troels Kjaer, Hans Høgenhaven, Annelise Smed, Jens Juul Holst, Flemming Dela, Frans Boomsma, Birger Thorsteinsson, Thomas Høi-Hansen, Ulrik Pedersen-Bjergaard, Rikke Due Andersen, Peter Lommer Kristensen, Carsten Thomsen, Troels Kjaer, Hans Høgenhaven, Annelise Smed & 4 others Jens Juul Holst, Flemming Dela, Frans Boomsma, Birger Thorsteinsson

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.
Original languageEnglish
JournalJournal of the Renin-Angiotensin-Aldosterone System
Volume10
Issue number4
Pages (from-to)216-29
Number of pages13
ISSN1470-3203
DOIs
Publication statusPublished - 2009

Bibliographical note

Keywords: Adult; Blood Glucose; Cognition; Diabetes Mellitus, Type 1; Electroencephalography; Evoked Potentials, Auditory; Female; Humans; Hypoglycemia; Insulin; Male; Middle Aged; Psychomotor Performance; Renin-Angiotensin System

ID: 18367479