A new diagnostic tool for severe hypoglycemia could be developed for people with impaired hypo awareness, researchers have said.
US scientists believe that measuring the amount of acetate used in a person’s brain could determine whether they have hypo unawareness, or an increased risk of losing their hypo awareness.
The brains of people with diabetes have to adapt during hypoglycemia, when less glucose is available, by increasing the use of alternative energy sources, such as acetate.
Researchers from LSU Pennington Biomedical Research Center tested this hypothesis on young metabolically healthy males who embarked upon a 72-hour fast. Their production of acetate was measured and episodes of low blood sugar were monitored using continuous glucose monitoring.
There was a high frequency of hypoglycemic episodes, and production of acetate increased. Interestingly, those with greater acetate production prior to the study experienced a greater increase in the duration of hypoglycemia.
“The results of our study suggest that this adaptation may still be present after exposure to times of low blood sugar and therefore can be used to measure how frequently a person experiences low blood sugar,” said lead author Dr David McDougal, PhD, assistant professor-research and head of Pennington Biomedical’s Neurobiology of Metabolic Dysfunction Laboratory.
“We believe that by measuring how well a person’s brain uses acetate, we might one day be able to determine if they are suffering from [hypoglycemia-associated autonomic failure] or are at increased risk for developing the condition in the near future.”
Hypoglycemia-associated autonomic failure (HAAF) describes an inability of the brain to recognise hypoglycemia and its inability to deal with a hypo by raising blood sugar.
“There is currently no objective way for a healthcare provider to measure whether a patient has experienced repeated episodes of low blood sugar and therefore may be suffering from HAAF,” added Dr McDougal.
He added that measuring acetate could therefore assist doctors in providing or altering treatment, such as recommending the use of a CGM, in order to reduce HAAF among people with diabetes.
The researchers concluded that future studies will be required to demonstrate if measuring acetate can be of “practical, clinical use”.

The results have been published online in the journal Diabetologia.
Editor’s note: People with diabetes can develop hypo unawareness if they experience long periods of time with low blood sugar. If you are struggling with recognising the signs of hypoglycemia, visit the Hypo Training Program, which has been developed to help people to develop skills to lessen the effects of hypo unawareness.

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