Hypoglycemia in adults with Type 1 Diabetes Mellitus: Investigating symptoms and awareness of hypoglycemia and the association between impaired awareness of hypoglycemia, autonomic neuropathy and cognition
Doctoral thesis
Permanent lenke
http://hdl.handle.net/11250/2423585Utgivelsesdato
2016Metadata
Vis full innførselSamlinger
Sammendrag
Hypoglycemia is still the main limitation for the management of Type 1 diabetes mellitus
(T1DM). If it were not for hypoglycemia, treatment of T1DM would be easy. Subjects with
T1DM have impaired defense mechanisms against hypoglycemia; this makes them
dependent on symptoms in order to detect a hypoglycemic episode and take appropriate
action to restore blood glucose levels. Impaired awareness of hypoglycemia (IAH) is a
reduced ability to perceive the onset of hypoglycemia. Subjects with IAH thereby have
increased risk for development of severe hypoglycemia.
We wanted to investigate the symptomatology of hypoglycemia in relation to diabetes
duration. In addition, we wanted to investigate if symptom intensity is associated with IAH.
We found that lower autonomic symptom intensity and a predominance neuroglycopenic
symptoms, is associated with longer diabetes duration. We found IAH to be associated with
higher overall- and higher neuroglycopenic symptom intensity, but not with lower
autonomic symptom intensity.
Activation of the autonomic nervous system is important for counterregulation during
hypoglycemia. Although results of previous studies have not been convincing of such an
association, it has almost been regarded as an unwritten truth that autonomic neuropathy
contributes to the development of IAH. We therefore found it appropriate to investigate this
hypothesis. We did not find any association between IAH and autonomic neuropathy.
Cognitive impairment is getting increasing recognition as a complication of T1DM. It is likely
that cognitive impairment affects diabetes self-management. We wanted to investigate if
cognitive impairment is associated with IAH. We found IAH to be associated with impaired
memory, learning, pattern separation and possibly also executive function.