48-OR: Changes in Global Cerebral Blood Flow in Response to Hypoglycemia in Type 1 Diabetes Do Not Influence Awareness Status

Brain responses to low plasma glucose may be key to understanding the behaviors that prevent severe hypoglycemia in type 1 diabetes. This study investigated the impact of long duration, hypoglycemia aware type 1 diabetes on cerebral blood flow responses to hypoglycemia. Three-dimensional pseudo-continuous arterial spin labeling magnetic resonance imaging was performed in 15 individuals with type 1 diabetes and 15 non-diabetic controls during a two-step hyperinsulinemic glucose clamp. Symptom, hormone, global cerebral blood flow and regional cerebral blood flow responses to hypoglycemia were measured. Epinephrine release during hypoglycemia was attenuated in type 1 diabetes, but symptom score rose comparably in both groups. A rise in global cerebral blood flow did not differ between groups. Regional cerebral blood flow increased in the thalamus and fell in the hippocampus and temporal cortex in both groups. Type 1 diabetes demonstrated lesser anterior cingulate cortex activation; however, this difference did not survive correction for multiple comparisons. Thalamic cerebral blood flow change correlated with autonomic symptoms, and anterior cingulate cortex cerebral blood flow change correlated with epinephrine response across groups. The thalamus may thus be involved in symptom responses to hypoglycemia, independent of epinephrine action, while anterior cingulate cortex activation may be linked to counterregulation. Activation of these regions may have a role in hypoglycemia awareness and avoidance of problematic hypoglycemia.

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Cerebral blood flow response to hypoglycemia is altered in patients with type 1 diabetes and impaired awareness of hypoglycemia

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x16658914 ◽

2016 ◽

Vol 37 (6) ◽

pp. 1994-2001 ◽

Cited By ~ 11

Author(s):

Evita C Wiegers ◽

Kirsten M Becker ◽

Hanne M Rooijackers ◽

Federico C von Samson-Himmelstjerna ◽

Cees J Tack ◽

...

Keyword(s):

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Brain Regions ◽

Autonomic Response ◽

Healthy Controls ◽

Impaired Awareness ◽

Global Cerebral Blood Flow ◽

Diabetes Patients

It is unclear whether cerebral blood flow responses to hypoglycemia are altered in people with type 1 diabetes and impaired awareness of hypoglycemia. The aim of this study was to investigate the effect of hypoglycemia on both global and regional cerebral blood flow in type 1 diabetes patients with impaired awareness of hypoglycemia, type 1 diabetes patients with normal awareness of hypoglycemia and healthy controls ( n = 7 per group). The subjects underwent a hyperinsulinemic euglycemic–hypoglycemic glucose clamp in a 3 T MR system. Global and regional changes in cerebral blood flow were determined by arterial spin labeling magnetic resonance imaging, at the end of both glycemic phases. Hypoglycemia generated typical symptoms in patients with type 1 diabetes and normal awareness of hypoglycemia and healthy controls, but not in patients with impaired awareness of hypoglycemia. Conversely, hypoglycemia increased global cerebral blood flow in patients with impaired awareness of hypoglycemia, which was not observed in the other two groups. Regionally, hypoglycemia caused a redistribution of cerebral blood flow towards the thalamus of both patients with normal awareness of hypoglycemia and healthy controls, consistent with activation of brain regions associated with the autonomic response to hypoglycemia. No such redistribution was found in the patients with impaired awareness of hypoglycemia. An increase in global cerebral blood flow may enhance nutrient supply to the brain, hence suppressing symptomatic awareness of hypoglycemia. Altogether these results suggest that changes in cerebral blood flow during hypoglycemia contribute to impaired awareness of hypoglycemia.

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Effects of hypoglycaemia on working memory and regional cerebral blood flow in type 1 diabetes: a randomised, crossover trial

Diabetologia ◽

10.1007/s00125-017-4502-1 ◽

2017 ◽

Vol 61 (3) ◽

pp. 551-561 ◽

Cited By ~ 7

Author(s):

Michael Gejl ◽

Albert Gjedde ◽

Birgitte Brock ◽

Arne Møller ◽

Eelco van Duinkerken ◽

...

Keyword(s):

Working Memory ◽

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Regional Cerebral Blood Flow ◽

Crossover Trial ◽

Regional Cerebral Blood

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Cerebral Blood Flow and Glucose Metabolism Measured With Positron Emission Tomography Are Decreased in Human Type 1 Diabetes

Diabetes ◽

10.2337/db12-1159 ◽

2013 ◽

Vol 62 (8) ◽

pp. 2898-2904 ◽

Cited By ~ 22

Author(s):

Larissa W. van Golen ◽

Marc C. Huisman ◽

Richard G. Ijzerman ◽

Nikie J. Hoetjes ◽

Lothar A. Schwarte ◽

...

Keyword(s):

Positron Emission Tomography ◽

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Glucose Metabolism ◽

Emission Tomography ◽

Human Type ◽

Positron Emission ◽

Human Type 1 Diabetes

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Basal ganglia cerebral blood flow associates with psychomotor speed in adults with type 1 diabetes

Brain Imaging and Behavior ◽

10.1007/s11682-017-9783-y ◽

2017 ◽

Vol 12 (5) ◽

pp. 1271-1278 ◽

Cited By ~ 4

Author(s):

John P. Ryan ◽

Howard J. Aizenstein ◽

Trevor J. Orchard ◽

Karen A. Nunley ◽

Helmet Karim ◽

...

Keyword(s):

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Basal Ganglia ◽

Psychomotor Speed

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Structural alterations in deep brain structures in type 1 diabetes

10.2337/figshare.12840641.v1 ◽

2020 ◽

Author(s):

Ada Admin ◽

Pavel Filip ◽

Antonietta Canna ◽

Amir Moheet ◽

Petr Bednarik ◽

...

Keyword(s):

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Brain Structures ◽

Cross Sectional Study ◽

Parahippocampal Gyrus ◽

Cross Sectional ◽

Vascular Disruption ◽

The Right

Even though well known in type 2 diabetes, the existence of brain changes in type 1 diabetes (T1D) and both their neuroanatomical and clinical features are less well characterized. To fill the void in the current understanding of this disease, we sought to determine the possible neural correlate in long-duration T1D at several levels including macrostructural, microstructural cerebral damage and blood flow alterations. In this cross-sectional study, we compared a cohort of 61 patients with T1D with an average disease duration of 21 years with 54 well-matched non-diabetic controls in a multimodal magnetic resonance imaging (MRI) protocol providing macrostructural metrics (cortical thickness and structural volumes), microstructural measures (T1w/T2w ratio as a marker myelin content, inflammation and oedema), and cerebral blood flow. T1D patients had higher T1w/T2w ratios in the right parahippocampal gyrus, the executive part of both putamina, both thalami and in the cerebellum. These alterations were reflected in lower putaminal and thalamic volume bilaterally. No cerebral blood flow differences between groups were found in any of these structures, suggesting non-vascular aetiologies of these changes. Our findings implicate a marked non-vascular disruption in T1D of several essential neural nodes engaged in both cognitive and motor processing.

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Structural alterations in deep brain structures in type 1 diabetes

10.2337/figshare.12840641 ◽

2020 ◽

Author(s):

Ada Admin ◽

Pavel Filip ◽

Antonietta Canna ◽

Amir Moheet ◽

Petr Bednarik ◽

...

Keyword(s):

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Brain Structures ◽

Cross Sectional Study ◽

Parahippocampal Gyrus ◽

Cross Sectional ◽

Vascular Disruption ◽

The Right

Even though well known in type 2 diabetes, the existence of brain changes in type 1 diabetes (T1D) and both their neuroanatomical and clinical features are less well characterized. To fill the void in the current understanding of this disease, we sought to determine the possible neural correlate in long-duration T1D at several levels including macrostructural, microstructural cerebral damage and blood flow alterations. In this cross-sectional study, we compared a cohort of 61 patients with T1D with an average disease duration of 21 years with 54 well-matched non-diabetic controls in a multimodal magnetic resonance imaging (MRI) protocol providing macrostructural metrics (cortical thickness and structural volumes), microstructural measures (T1w/T2w ratio as a marker myelin content, inflammation and oedema), and cerebral blood flow. T1D patients had higher T1w/T2w ratios in the right parahippocampal gyrus, the executive part of both putamina, both thalami and in the cerebellum. These alterations were reflected in lower putaminal and thalamic volume bilaterally. No cerebral blood flow differences between groups were found in any of these structures, suggesting non-vascular aetiologies of these changes. Our findings implicate a marked non-vascular disruption in T1D of several essential neural nodes engaged in both cognitive and motor processing.

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

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2012.117 ◽

2012 ◽

Vol 32 (11) ◽

pp. 2084-2090 ◽

Cited By ~ 28

Author(s):

Silvia Mangia ◽

Nolawit Tesfaye ◽

Federico De Martino ◽

Anjali F Kumar ◽

Pete Kollasch ◽

...

Keyword(s):

Body Mass Index ◽

Blood Flow ◽

Type 1 Diabetes ◽

Cerebral Blood Flow ◽

Blood Glucose ◽

Body Mass ◽

Early Phase ◽

Cerebral Activation ◽

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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Peculiarities of microcirculation in periodont tissues in children of key age groups sufficient type 1 diabetes. Part II

Periodontology ◽

10.33925/1683-3759-2019-24-2-108-119 ◽

2019 ◽

Vol 24 (2) ◽

pp. 108-119 ◽

Cited By ~ 2

Author(s):

B. N. Davydov ◽

D. A. Domenyuk ◽

S. V. Dmitrienko

Keyword(s):

Diabetes Mellitus ◽

Blood Flow ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Laser Doppler Flowmetry ◽

Laser Doppler ◽

Diabetic Microangiopathy ◽

Healthy Children ◽

Doppler Flowmetry

Relevance. Morpho-functional changes in peripheral circulation established in type 1 diabetes mellitus correlate with changes in central hemodynamics, allowing the use of microcirculation indicators as diagnostic and prognostic criteria for assessing the degree of functional vascular disorders. Identifcation of microcirculation features of the blood by the method of laser Doppler ﬂowmetry in children with diﬀerent experience of type 1 diabetes in key age categories.Materials and methods. The study included 67 children with type 1 diabetes mellitus aged 12-15 years with an experience of the disease from six months to ten years. The comparison group consisted of 38 healthy children. The state of the microvasculature was assessed by laser Doppler ﬂowmetry using a laser analyzer for capillary blood ﬂow LAKK-OP.Results. In children with an experience of type 1 diabetes of less than two years, microcirculation disorders in periodontal tissues correspond to the hyperemic form, accompanied by increased perfusion, a decrease in the amplitude of low-frequency oscillations, increased heart rate, high blood flling, and blood ﬂow bypass. For children with an endocrinopathy experience of more than three years, microcirculation disorders correspond to a stagnant form, combined with a decrease in perfusion due to stagnation of blood in the venular link, endothelial domination with suppression of neurogenic and cardiac ﬂuctuations, low efciency and redistribution of blood ﬂow in favor of the nutritive link.Conclusions. With the increase in experience, the degree of compensation of type 1 diabetes, the progression of diabetic microangiopathy, it is advisable to designate two stages of development of microcirculatory disorders. Early – compensatory with active adaptation, including neurogenic and endothelial regulation mechanisms. Late – decompensation with passive adaptation, supporting the eﬀectiveness of microcirculation due to myogenic control of regulation, shunting and increasing the rate of blood outﬂow.

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