4.3 Review

Remembrance of things past: The consequences of recurrent hypoglycaemia in diabetes

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Consequences of recurrent hypoglycaemia on brain function in diabetes

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Summary: The discovery and mass manufacture of insulin transformed the lives of diabetes patients, but also brought the risk of hypoglycemia. Recurrent hypoglycemia may impact cells critical for glucose regulation in the brain, exacerbating oxidative stress and inflammation caused by chronic hyperglycemia, leading to brain damage and cognitive decline. Combining prior glycemic control, hypoglycemia, and rebound hyperglycemia synergistically accelerates oxidative stress and inflammation, contributing to the complications of diabetes.

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Cold-induced dishabituation in rodents exposed to recurrent hypoglycaemia

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Summary: Non-diabetic rodents show two cardinal features of habituation, namely stimulus generalization and dishabituation. These findings further support the hypothesis that suppressed counterregulatory responses following exposure to recurrent hypoglycemia in diabetes result from habituation.

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Summary: In a 32-year follow-up study of individuals with type 1 diabetes, substantial declines in memory and psychomotor and mental efficiency were observed. Higher HbA(1c) levels, more episodes of severe hypoglycemia, and elevated systolic blood pressure were independently associated with greater decrements in mental efficiency over time. Better management of glucose and blood pressure levels could potentially help preserve cognitive function in individuals with type 1 diabetes.

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Type 1 corticotropin-releasing factor receptors in the ventromedial hypothalamus promote hypoglycemia-induced hormonal counterregulation

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