Long term effects of hypos?

[gavin86]

So...
A hypo starves your body and brain... It would make sense if there were long term effects. Nobody ever mentions it though in education...

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[Deleted Account]

Doing a quick Google on the topic, it seems to be because the scientists have been unable to distinguish between the long term affects of hypos from the long term effects of having diabetes. For example (RH is hypoglycaemia)

"There have been several attempts to determine the neural and cognitive impact of RH, but results have been mixed. The human literature contains reports of RH producing enhanced, impaired, or unaffected subsequent cognitive function. The lack of uniformity is likely due in large part to difficulty in controlling and determining the glycemic history of diabetic patients and to the confounds unavoidably introduced by individual variations in hypoglycemic history, exposure to hyperglycemia, cerebrovascular and neuropathic conditions, and chronic illness."

 

[Juicyj]

Hi @gavin86 No they don't mention it in DAFNE, however if you chat to your DSN about it they will tell you that they should be avoided as much as possible, according to the last conversation I had with a HCP they said that they can cause damage, hence why they have to be avoided as much as possible, sadly the reality is they are part of our lives and cannot be avoided.

 

[Snapsy]

A few years ago I had my annual review and my appointment was with a registrar who sent me into a massive panic - she was concerned about my frequent hypos and said 'you are too young to be losing so many neurons'.

For the record, she had no evidence that I had lost any.

I had a phone call from my DSN the following week asking me if I had any concerns about my review, because the person I had seen was no longer working there. I hadn't even said anything at the time, and I got the impression I wasn't the only one to be called!

I asked my DSN about the 'losing neurons' issue, and got a rather fudged reply about it being desirable to avoid hypos.

So no clear answer - but I do wonder, @gavin86

 

[leslie10152]

So...
A hypo starves your body and brain... It would make sense if there were long term effects. Nobody ever mentions it though in education...

Sent from my HTC 2PST1 using Diabetes.co.uk Forum mobile app

I 've done some reading on longterm effects of hypoglycaemia, and as yet there appears no hard core evidence to prove any permanent brain or other nerve damage. Even so, it is advisable to avoid hypos as much as possible.

 

[noblehead]

No they don't mention it in DAFNE

No they don't, but we brought the subject up in the Q&A session with the Consultant.

At the time he said there was some on-going research into the long-term effects of frequent hypoglycemia and the results would be eventually published, he didn't say a lot on the subject except to say that they are best avoided (which is just stating the obvious). Never did find out anymore about the study or the outcome (as the Consultant move on to pastures new).

Surely if there was any long-term risks/damage much would depend on the frequency of the hypo's, how far bg levels drop and the duration of the hypo's (just my own thoughts).

 

[Bon83]

I glanced over an article a few years ago on long term damage of hypos and it was very whooly. It insinuated that it increased the risk of dementia - however there are so many things accused of causing dementia and cancer as well. I would be concerned about how they got quality info in these studies as there are so many environmental factors - like general diet and exercise that have much more impact than the hypos on health. I think the medical community are very focused on the immidiate impact of hypos- for obvious reason in case your driving or hurt yourself. I was taken aback by the nurse in the doctors labouring the point constantly throughout the appointment, however she was not able to offer me any more advice about how to avoid them apart from jelly beans in my pocket. I think earlier on insulin users need to be told how to find out about the complexities of insulin. I had a hypo early on because I didn't know some quite simple exercise and insulin basics.

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[lindisfel]

If you have hypos, as in RH, it makes Hba1c assessment erroneous in the damage caused to ones body. I used to have two hypos a day before I went low carb. If tissue doesn't get nourished properly damage must surely be consequential? Derek

 

[catapillar]

So, hypos under 2 are thought to kill brain cells and risk decline in cognitive function. This is putative risk, because you can't actually see whether it does by doing cognitive function tests and then forcing a hypo before doing another one to compare.

Brief research suggests it's all very putative, unproven.

Brief research:

·Jacobsen et al "Long-Term Effect of Diabetes and its Treatment on Cognitive Function" 2007 (356) New England Journal of Medicine 1842 – found no correlation between episodes of severe hypoglycaemia and lasting effect on cognitive function;

·Munsen et al "Impact of Diabetes and Its Treatment on Cognitive Function Among Adolescents Who Participated in the Diabetes Control and Complications Trial" 2008 Diabetes Care (31, 10) 1933 – found no association between frequency of hypoglycaemia and decline on any cognitive domain.

·Seaquist et al "A Report of a Workgroup of the American Diabetes Association and The Endocrine Society" 2015 Diabetes Care (36, 5) 1384 – considered more work was necessary to understand the significance of hypoglycaemic episodes on the long term cognitive ability of adults with type 1 diabetes.

·Ewan et al "Mini-Review: Impact of recurrent hypoglycaemia on cognitive and brain function" Physiology & Behaviour 100(3) 234 – recurrent hypoglycaemia appears to cause brain adaptations which may enhance cognitive performance and fuel supply when euglycemic.

·Puente et al "Recurrent Moderate Hypoglycaemia Ameliorates Brain Damage and Cognitive Dysfunction Induced by Severe Hypoglycaemia" 2010 Diabetes Journals (59,4) 1055 - changes brought about by recurrent moderate hypoglycaemia can be viewed, paradoxically, as providing a beneficial adaptive response in that there is mitigation against severe hypoglycaemia–induced brain damage and cognitive dysfunction.


http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2701294&blobtype=pdf

3 May 2007 New England Journal of Medicine 356:1842–1852 Jacobsen et al "Long-Term Effect of Diabetes and Its Treatment on Cognitive Function" – study on whether episodes of severe hypoglycaemia has any lasting effect on cognitive function – found no correlation?

http://care.diabetesjournals.org/content/31/10/1933.full

Musen et al, "Impact of Diabetes and Its Treatment on Cognitive Function Among Adolescents Who Participated in the Diabetes Control and Complications Trial" 7 July 2008 Diabetes Care (31, 10) 1933

There were a total of 294 reported episodes of coma or seizure. Neither frequency of hypoglycemia nor previous treatment group was associated with decline on any cognitive domain. As in a previous analysis of the entire study cohort, higher A1C values were associated with declines in the psychomotor and mental efficiency domain (P < 0.01); however, the previous finding of improved motor speed with lower A1C values was not replicated in this subgroup analysis.

http://care.diabetesjournals.org/content/36/5/1384.full

Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society, Seaquist et al Diabetes care 15 April 2013 (36, 5) 1384

-Despite such reassuring findings, recent investigation with advanced imaging techniques has demonstrated that adults with type 1 diabetes appear to call upon a greater volume of the brain to perform a working memory task during hypoglycemia (45). These findings suggest that adults with type 1 diabetes must recruit more regions to preserve cognitive function during hypoglycemia than adults without the disease. More work will be necessary to understand the significance of these observations on the long-term cognitive ability of adults with type 1 diabetes.

http://care.diabetesjournals.org/content/33/9/1945.full.pdf+html

Asvold et al "Cognitive Function in Type 1 Diabetic Adults with Early Exposure to Severe Hypoclycemia" Diabetes Care 2010 (33,9) 1945

The findings suggest that early (childhood) exposure to SH may have lasting and clinically relevant effects on cognition….Possibly the developing brain is particularly vulnerable to the effects of SH (2,3,5,6,11). Unlike

previous long-term studies, we specifically included diabetic subjects with exposure to SH in early childhood.

This could explain why our data suggest larger persistent cognitive decline than previously reported in the studies of early- onset diabetes or SH in childhood.


Mini-review: Impact of recurrent hypoglycemia on cognitive and brain function
Physiology & Behavior, Volume 100, Issue 3, Pages 234-238
Ewan C. McNay, Victoria E. Cotero


Overall, RH appears to cause brain adaptations which may enhance cognitive performance and fuel supply when euglycemic but which pose significant threats during future hypoglycemic episodes.


http://diabetes.diabetesjournals.org/content/59/4/1055.full


Puente et al "Recurrent Moderate Hypoclycemia Ameliorates Brain Damage and Cognitive Dysfunction Induced by Severe Hypoglycemia" 19 January 2010 Diabetes (59,4) 1055


Antecedent recurrent moderate hypoglycemia preconditioned the brain and markedly limited both the extent of severe hypoglycemia–induced neuronal damage and associated cognitive impairment. In conclusion, changes brought about by recurrent moderate hypoglycemia can be viewed, paradoxically, as providing a beneficial adaptive response in that there is mitigation against severe hypoglycemia–induced brain damage and cognitive dysfunction.


http://archinte.jamanetwork.com/article.aspx?articleid=1696172


Yaffe et al "Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus". JAMA Intern Med. 2013;173(14):1300-1306.


Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.


http://link.springer.com/article/10.1007/s00125-010-1983-6#page-2


Frier "Cognitive functioning in type 1 diabetes: the DCCT revisited" February 2011 Dibabetologia (54, 2) 233


This has revealed associations between mild impairment of psychomotor efficiency and hypertension, glycaemic control and the presence of retinopathy and nephropathy, while smoking history was associated with modest abnormalities in several cognitive domains. Neither macrovascular risk factors nor a history of severe hypoglycaemia was associated with the cognitive decrements; cerebral microangiopathy has been proposed as a possible underlying cause.