Der Diabetologe

, Volume 13, Issue 1, pp 47–62 | Cite as

Diabetes und Zentralnervensystem

CME
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Zusammenfassung

Diabetes erhöht das Risiko für einen Schlaganfall um den Faktor 2–4. In dessen Primär- und Sekundärprophylaxe war eine strenge Blutzuckerkontrolle allein einer Standardtherapie nicht überlegen; allerdings konnte das Schlaganfallrisiko von Diabetespatienten im Rahmen multimodaler Maßnahmen in den letzten 20 Jahren um etwa 50 % gesenkt werden. Bei 50 % der Schlaganfallpatienten finden sich in der Akutphase erhöhte Glukosewerte (Post-Stroke-Hyperglykämie (PSH)), die einen Indikator für eine schlechtere Prognose darstellen. Die potenziell günstige Wirkung einer strengen i. v. Insulingabe auf die PSH wird aber in der Praxis durch negative Effekte vermehrt auftretender Hypoglykämien neutralisiert. Auch das Risiko für die Entwicklung einer vaskulären, aber auch einer neurodegenerativen Demenz vom Alzheimer-Typ ist bei Diabetes erhöht. Rezidivierende Hypoglykämien beeinträchtigen durch zerebral vermittelte Mechanismen die rechtzeitige Wahrnehmung der Unterzuckerung.

Schlüsselwörter

Gehirn Schlaganfall Demenz Hypoglykämie Hyperglykämie 

Diabetes and the central nervous system

Abstract

Diabetes increases the risk of stroke by a factor of 2–4. For primary and secondary stroke prevention, strict glycemic control alone was not superior to standard treatment. However, the risk of stroke in patients with diabetes could be reduced by multimodal risk interventions during the last 20 years by about 50%. Increased glucose levels (poststroke hyperglycemia (PSH)) which indicate a worse prognosis develop in 50% of stroke patients. The potentially beneficial effect of strict glycemic control in PSH by i. v. insulin was neutralized by negative effects of an increased rate of hypoglycemic episodes. Diabetes leads to an increased risk of vascular dementia, but also of the neurodegenerative Alzheimer ’s type. Recurrent hypoglycemic episodes affect the timely perception of hypoglycemia by cerebral-mediated mechanisms, which reduces the possibility of counterreactions.

Keywords

Brain Stroke Dementia Hypoglycemia Hyperglycemia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Erbguth gibt an, im Zusammenhang mit dem Thema Vortrags- und Beratungshonorare von Boehringer Ingelheim Pharma GmbH erhalten zu haben.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Klinik für Neurologie, Klinikum NürnbergParacelsus Medizinische PrivatuniversitätNürnbergDeutschland

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