Hypoglycemia-Induced Increases in Thalamic Cerebral Blood Flow are Blunted in Subjects with Type 1 Diabetes and Hypoglycemia Unawareness

The thalamus has been found to be activated during the early phase of moderate hypoglycemia. Here, we tested the hypothesis that this region is less activated during hypoglycemia in subjects with type 1 diabetes (T1DM) and hypoglycemia unawareness relative to controls. Twelve controls (5 F/7 M, age 40 ± 14 years, body mass index 24.2 ± 2.7 kg/m2) and eleven patients (7 F/4 M, age 39 ± 13 years, body mass index 26.5 ± 4.4 kg/m2) with well-controlled T1DM (A1c 6.8 ± 0.4%) underwent a two-step hyperinsulinemic (2.0 mU/kg per minute) clamp. Cerebral blood flow (CBF) weighted images were acquired using arterial spin labeling to monitor cerebral activation in the midbrain regions. Blood glucose was first held at 95 mg/dL and then allowed to decrease to 50 mg/dL. The CBF image acquisition during euglycemia and hypoglycemia began within a few minutes of when the target blood glucose values were reached. Hypoglycemia unaware T1DM subjects displayed blunting of the physiologic CBF increase that occurs in the thalamus of healthy individuals during the early phase of moderate hypoglycemia. A positive correlation was observed between thalamic response and epinephrine response to hypoglycemia, suggesting that this region may be involved in the coordination of the counter regulatory response to hypoglycemia.

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Body Mass Index Effect on Differing Responses to Psychological Stress in Blood Glucose Dynamics in Patients With Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296818758103 ◽

2018 ◽

Vol 12 (3) ◽

pp. 657-664 ◽

Cited By ~ 1

Author(s):

Basak Ozaslan ◽

Stephen D. Patek ◽

Jesse H. Grabman ◽

Jaclyn A. Shepard ◽

Eyal Dassau ◽

...

Keyword(s):

Body Mass Index ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Psychological Stress ◽

Body Mass ◽

Carbohydrate Intake ◽

Mixed Effect ◽

Stress Levels ◽

Effectiveness Index

Objective: The objective was to investigate the relationship of body mass index (BMI) to differing glycemic responses to psychological stress in patients with type 1 diabetes. Methods: Continuous blood glucose monitor (CGM) data were collected for 1 week from a total of 37 patients with BMI ranging from 21.5-39.4 kg/m2 (mean = 28.2 ± 4.9). Patients reported daily stress levels (5-point Likert-type scale, 0 = none, 4 = extreme), physical activity, carbohydrate intake, insulin boluses and basal rates. Daily reported carbohydrates, total insulin bolus, and average blood glucose (BG from CGM) were compared among patients based on their BMI levels on days with different stress levels. In addition, daily averages of a model-based “effectiveness index” (quantifying the combined impact of insulin and carbohydrate on glucose levels) were defined and compared across stress levels to capture meal and insulin independent glycemic changes. Results: Analyses showed that patient BMI likely moderated stress related glycemic changes. Linear mixed effect model results were significant for the stress-BMI interaction on both behavioral and behavior-independent glycemic changes. Across participants, under stress, an increase was observed in daily carbohydrate intake and effectiveness index at higher BMI. There was no significant interactive effect on daily insulin or average BG. Conclusion: Findings suggest that (1) stress has both behavioral and nonbehavioral glycemic effects on T1D patients and (2) the direction and magnitude of these effects are potentially influenced by level of stress and patient BMI. Possibly responsible for these observed effects are T1D/BMI related alterations in endocrine response.

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Acute response of intermittent and continuous aerobic exercises on blood glucose of adolescents

Revista Brasileira de Atividade Física & Saúde ◽

10.12820/rbafs.v.22n4p396-403 ◽

2017 ◽

Vol 22 (4) ◽

pp. 396-403

Author(s):

Valderi Lima ◽

Luis Mascarenhas ◽

Juliana Decimo ◽

William Souza ◽

Suzana França ◽

...

Keyword(s):

Body Mass Index ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Body Mass ◽

Intermittent Exercise ◽

Z Score ◽

Exercise Protocol ◽

Continuous Exercise ◽

Significant Difference

The purpose of the study was to investigate the acute effect of continuous and intermittent aerobic exercise on blood glucose of adolescents with type 1 diabetes. A cross-sectional analysis of eight adolescents with type 1 diabetes mellitus (10-15 years) was conducted, and variables such as body mass, height, body mass index z score, glycated hemoglobin and cardiorespiratory fitness were assessed. There were two tests on a cycle ergometer: 30 minutes of continuous exercise and 30 minutes of intermittent exercise. Blood glucose was measured before and after the exercises and lactate concentration was measured at the end of the exercise. Student’s t test and Pearson’s correlation were used, considering p<0.05. In the continuous exercise protocol, there was a significant difference in pre- and post-exercise blood glucose levels (p = 0.048), whereas the intermittent exercise protocol did not show statistically significant differences in blood glucose. Higher concentrations of lactate were found after the intermittent exercises (p = 0.036). There was a strong correlation between glycemic control and body mass index z score (r = 0.893 p = 0.041). Regarding the other variables, there were no significant correlations. The reduction in blood glucose was lower after intermittent aerobic exercises, compared with continuous exercises, which could be an interesting strategy to prevent acute exercise-induced hypoglycemia.

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Relationship between hypoglycaemia, body mass index and quality of life among patients with type 1 diabetes: Observations from the DEPICT clinical trial programme

Diabetes Obesity and Metabolism ◽

10.1111/dom.13972 ◽

2020 ◽

Vol 22 (5) ◽

pp. 857-865

Author(s):

Jason Gordon ◽

Lee Beresford‐Hulme ◽

Hayley Bennett ◽

Amarjeet Tank ◽

Christopher Edmonds ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Body Mass Index ◽

Type 1 Diabetes ◽

Body Mass ◽

Clinical Trial Programme

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Effects of Metformin Added to Insulin in Adolescents with Type 1 Diabetes: An Exploratory Crossover Randomized Trial

Journal of Diabetes Research ◽

10.1155/2020/7419345 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Daizhi Yang ◽

Jinhua Yan ◽

Hongrong Deng ◽

Xubin Yang ◽

Sihui Luo ◽

...

Keyword(s):

Body Mass Index ◽

Heart Rate ◽

Heart Rate Variability ◽

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Body Mass ◽

Autonomic Function ◽

Insulin Dose ◽

Glucose Variability

Background. To comprehensively assess the effects of metformin added to insulin on metabolic control, insulin sensitivity, and cardiovascular autonomic function in adolescents with type 1 diabetes. Materials and Methods. This was an exploratory, crossover, randomized trial conducted in adolescents with type 1 diabetes aged 12-18 years old. Participants were randomly received metformin (≤1000 mg/d) added to insulin for 24 weeks followed by insulin monotherapy for a subsequent 24 weeks or vice versa. Blood pressure, body mass index, insulin dose, estimated insulin sensitivity, glycated hemoglobin A1c (HbA1c), and lipid profiles were measured, with a 72-hour continuous glucose monitoring and 24-hour Holter monitoring performed at baseline, 24, and 50 weeks for the assessments of glucose variability and heart rate variability. Results. Seventeen patients with mean ± SD age 14.4 ± 2.3 years , body mass index 18.17 ± 1.81 kg / m 2 , median (IQR) diabetes duration 4.50 (3.58, 6.92) years, and HbA1c 9.0% (8.5%, 9.4%) were enrolled. The between-group difference in HbA1c of 0.28% (95% CI -0.39 to 0.95%) was not significant ( P = 0.40 ). Changes in body mass index, insulin dose, blood pressure, lipid profiles, and estimated insulin sensitivity were similar for metformin add-on vs. insulin monotherapy. Glucose variability also did not differ. Compared with insulin monotherapy, metformin add-on significantly increased multiple heart rate variability parameters. Conclusions. Metformin added to insulin did not improve metabolic control or glucose variability in lean/normal-weight adolescents with type 1 diabetes. However, metformin added to insulin significantly increased heart rate variability, suggesting that metformin might improve cardiovascular autonomic function in this population.

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