Severe hypoglycaemia and cognitive impairment in diabetes

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Abstract
The human brain accounts for about 20% of the body's metabolic consumption and is obliged to use glucose exclusively as its fuel. Therefore, when it is temporarily starved of glucose, brain functions suffer: thinking processes are impaired and a tense, tired mood state ensues. If profound neuroglycopenia continues untreated the result may be coma, seizure, and (rarely) severe brain damage. Hypoglycaemia is associated with significant morbidity and accounts for about 1-2% of deaths among diabetic patients,2 although this is still much lower than the mortality from diabetic ketoacidosis (6%). The severity of hypoglycaemia is defined by individuals' ability to treat themselves: severe episodes are those that require help from a third party to effect recovery. For people with insulin dependent diabetes, hypoglycaemia is the most feared side effect of treatment. Because episodes of severe hypoglycaemia can involve relatively prolonged neuroglycopenia, concern has arisen about their long term effects on brain function. …