Brain injury from hypoglycemia – how best to measure
Professor Anthony L McCall of the Editorial Board
Diabetic Hypoglycemia Oct 2010, Volume 3, Issue 2: page 1-2
In this issue’s Feature Article, Arbelaez and Hershey have provided a thoughtful and critical review of the value and limitations of imaging analysis to examine clinically relevant brain changes after hypoglycemia.
The brain organizes hypoglycemia defenses, but it is also a primary recipient of damage from severe and repeated hypoglycemia. The brain has the potential both for adaptation and either rapid or long-term damage. The brain is quite heterogeneous in its rates for glucose consumption. This is one factor, but not the only one, that creates susceptibility for brain damage from hypoglycemia. Classically, based on case reports, the areas of the brain with high glucose consumption, such as certain cortical regions, the hippocampus and subcortical sensory relay areas were thought to be particularly susceptible to hypoglycemia damage while the cerebellum was thought to be resistant. As Arbelaez and Hershey review however, newer imaging techniques and better controlled and prospective observations suggest this classic pattern may not be entirely correct and they point out the importance of interneurons as a target of hypoglycemia damage due to their high metabolic rate.