January 31, 2006
Question from Milwaukee, Wisconsin, USA:
I get very concerned when I read about the negative cognitive effects of diabetes, especially brain atrophy and decreased processing speed. What is the cause? Is there any way to prevent such cognitive effects? Would insulin regimen have an effect (i.e., Lantus, pump)?
Be more concerned with ways to control blood glucose levels. We were originally worried more about hypoglycemia and brain function, but it appears from more recent studies in Zurich (Shoenle et al.) and Australia (Verge et al.) that hyperglycemia has more serious deleterious effects on brain function than hypoglycemia. At the moment one is hypoglycemic, clearly the brain does not work so well. But long term, the high sugars are far more damaging even than isolated severe hypoglycemic episodes. So, blood sugar goals remain critically important not just for preventing long term nerve and cardiovascular problems but also for brain function itself.
No specific insulin program is better or worse since it is the application and achievement of blood glucose control goals that is so critical. Pumps are terrific. So are intensified multi-dose insulin regimens. Most everything is based on frequent blood sugar monitoring, meal planning and knowledge that can be applied to changes in food, activity, growth, illness etc. as we try to mimic what the pancreas used to be able to do.
[Editor’s comment: For related information, see Hypoglycaemia and Cognitive Function; Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes; Neurocognitive correlates of type 1 diabetes mellitus in childhood; The effects of glucose fluctuation on cognitive function and QOL: the functional costs of hypoglycaemia and hyperglycaemia among adults with type 1 or type 2 diabetes; and Acute hyperglycaemia impairs cognitive function in children with IDDM.