Does Central Nervous System Adaptation to Antecedent Glycemia Occur in Patients with Insulin-Dependent Diabetes Mellitus?
Authors: PHILIP E. CRYER
Journal: Annals of Internal Medicine (1985)

Editorials1 August 1985Does Central Nervous System Adaptation to Antecedent Glycemia Occur in Patients with Insulin-Dependent Diabetes Mellitus?PHILIP E. CRYER, M.D.PHILIP E. CRYER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-103-2-284 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptGlucose derived from the circulation is the predominant metabolic fuel used by the central nervous system under most physiologic conditions. Hypoglycemia causes brain dysfunction (neuroglycopenia) and can cause brain death, because it deprives the central nervous system neurons of this critical fuel. Thus, it is not surprising that effective glucose counterregulatory mechanisms evolved. Indeed, in all persons except those who use drugs that lower the plasma glucose concentration, hypoglycemia is an unusual clinical event.The prevention or correction of hypoglycemia is normally the result of both dissipation of insulin and activation of glucose counterregulatory systems (1, 2). Insulin suppresses hepatic...References1. CRYERTSECLUTTERSHAH PTWS. The roles of glucagon and epinephrine in hypoglycemic and nonhypoglycemic glucose counterregulation in man. Am J Physiol. 1984;247(2 pt 1):E198-E205. MedlineGoogle Scholar2. CRYERGERICH PJ. Glucose counterregulation, hypoglycemia and intensive insulin therapy of diabetes mellitus. N Engl J Med. (in press.) Google Scholar3. DEFEOVENTURAPERRIELLODECOSMOBRUNETTI PMGSP. Counterregulatory role of growth hormone and cortisol in prolonged hypoglycemia [Abstract]. Diabetes. 1985;34(suppl 1):100A. Google Scholar4. BOLLIDEFEOPERRIELLO GPG. Role of hepatic autoregulation in defense against hypoglycemia in humans. 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Importance of glucose control for the recovery from hypoglycemia in insulin-dependent diabetics. Diabetes. 1982;31:771-5. CrossrefMedlineGoogle Scholar18. GJEDDECRONE AC. Blood-brain glucose transfer: repression in chronic hyperglycemia. Science. 1981;214:456-7. CrossrefMedlineGoogle Scholar19. MCCALLMILLINGTONWURTMAN AWR. Metabolic fuel and amino acid transport into the brain in experimental diabetes mellitus. Proc Natl Acad Sci USA. 1982;79:5406-10. CrossrefMedlineGoogle Scholar20. MCCALLTORNHEIMFLEMINGRUDERMAN AKNN. Brain transport and metabolism in chronic hypoglycemia [Abstract]. Diabetes. 1985;34(suppl 1):37A. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. 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