Zusammenfassung
Bei einer Hypoglykämie sinken Blut- bzw. Plasmaglukosespiegel ab und können — unabhängig von der Ursache — im Extremfall zu einer Minderversorgung des Gehirns mit Glukose führen. Das menschliche Gehirn ist weitestgehend auf Glukose als Energielieferant angewiesen, verfügt aber weder über Synthesenoch über Speichermöglichkeiten, so dass die Aufrechterhaltung ausreichender Glukosespiegel in der Zirkulation entscheidend ist.
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Literatur
American Diabetes Association (1993) Position statement: implication of the diabetes control and complication trial. Clin Diabetes 11: 91–96
Amid SA, Tamborlane WV, Simonson DC, Sherwin RS (1987) Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med 316: 1376–1383
Amiel SA, Sherwin RS, Simonson DC, Tamborlane WV (1988) Effect of intensive insulin therapy on glycemic thresholds for counterregulatory hormone release. Diabetes 37: 901–907
Berger W (1985) Incidence of severe side effects during therapy with sulphonylureas and biguanides. Horm Metab Res 15: 111–115
Boado RJ, Pardridge WM (1993) Glucose deprivation causes posttranscriptional enhancement of brain capillary endothelial glucose transporter gene expression via GLUT-1 mRNA stabilization. J Neurochem 60: 2290–2296
Bolli G, DeFeo P, Compagnucci P, Cartechini MG, Angeletti G, Santeusiano F, Brunetti P, Gerich JE (1983) Abnormal glucose counter-regulation in insulin-dependent diabetes mellitus: interaction of anti-insulin antibodies and impaired glucagon and epinephrine secretion. Diabetes 32: 134–141
Boyle PJ, Schwartz NS, Shah SD, Clutter WE, Cryer PE (1988) Plasma glucose concentrations at the onset of hypoglycemic symptoms in patients with poorly controlled diabetes and in non-diabetics. N Engl J Med 318: 1487–1492
Boyle PJ, Nagy RJ, O’Connor AM, Kempers SF, Yeo RA, Qualls C (1994) Adaptation in brain glucose uptake following recurrent hypoglycemia. Proc Natl Acad Sci USA 91: 9352–9356
Boyle PJ, Kempers SF, O’Connor AM, Nagy RJ (1995) Brain glucose uptake and unawareness of hypoglycemia in patients with insulin-dependent diabetes mellitus. N Engl J Med 333: 1726–1731
Campbell IW (1985) Metformin and the sulphonylureas: the comparative risk. Horm Metab Res 15: 105–111
Chipkin SR, van Bueren A, Bercel E, McCall AL (1998) Effects of dexamethasone in vivo and in vitro on glucose transport in brain microvasculature. Neurochem Res 23: 649–656
Clarke BF, Campbell IW (1974) Long-term comparative trial of glibenclamide and chlorpropamide in diet-failed maturity onset diabetes. Lancet is 246–248
Clutter WE, Rizza RA, Gerich JE, Cryer PE (1988) Regulation of glucose metabolism by sympathochromaffin catecholamines. Diabetes Metab Rev 4: 1–15
Connell FA, Louden JM (1983) Diabetes mortality in persons under 45 years of age. Am J Public Health 73: 1174–1177
Cranston I, Lomas J, Maran A, Macdonald I, Amiel SA (1994) Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Lancet 344: 283–287
Cryer PE (1992) Iatrogenic hypoglycemia as a cause of hypoglycemia-associated autonomic failure in IDDM: A vicious circle. Diabetes 41: 255–260
Cryer PE (1993) Glucose counterregulation: the physiological mechanisms that prevent or correct hypoglycemia. In: Frier BM, Fisher BM (eds) Hypoglycaemia and diabetes: clinical and physiological aspects. Edward Arnold, London, pp 3455
Cryer PE, Gerich JE (1985) Glucose counterregulation, hypoglycemia and intensive insulin therapy in diabetes mellitus. N Engl J Med 313: 232–241
Dagogo-Jack SE, Craft S, Cryer PE (1993) Hypoglycemia-associated autonomic failure in insulin dependent diabetes mellitus. J Clin Invest 91: 819–828
Dagogo-Jack S, Rattararsan C, Cryer PE (1994) Reversal of hypoglycemia unawareness, but not defective glucose counter-regulation in IDDM. Diabetes 43: 1426–1434
Davis MR, Mellman M, Shamoon H (1992) Further defects in counter-regulatory responses induced by recurrent hypoglycemia in type 1 diabeties. Diabetes 41: 1335–1340
Davis SN, Shavers C, Costa F, Mosqueda-Garcia R (1996) Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans. J Clin Invest 98: 680–691
Davis SN, Dunham B, Walmsley K, Shavers C, Neal D, Williams P, Cherrington AD (1997a) Brain of the conscious dog is sensitive to physiological changes in circulatig insulin. Am J Physiol 272: E567–575
Davis SN, Shavers C, Davis B, Costa F (1997b) Prevention of an increase in plasma cortisol during hypoglycemia preservers subsequent counterregulatory responses. J Clin Invest 100: 429–438
DCCT Research Group (1987) Diabetes control and complications trial (DCCT): results of feasibility study. Diabetes Care 10: 1–19
DCCT Research Group (1991) Epidemiology of severe hypogly-cemia in the diabetes control and complication trial. Am J Med 90: 450–459
DCCT Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977–986
DCCT Research Group (1995) Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care 18: 1415–1427
DCCT Research Group (1996) Effects of intensive diabetes therapy on neuropsychological function in adults in the diabetes control and complications trial. Ann Intern Med 124: 379–388
DCCT Research Group (1998) Effect of intensive therapy on residual β-cell function in patients with type I diabetes in the diabetes control and complications trial. Ann Intern Med 128: 517–523
Deary IJ (1993) Effects of hypoglycaemia on cognitive function. In: Frier BM, Fisher BM (eds) Hypoglycaemia and diabetes: clinical and physiological aspects. Edward Arnold, London, pp 80–92
Deary IJ, Crawford JR, Hepburn DA, Langan SJ, Blackmore LM, Frier BM (1993a) Severe hypoglycemia and intelligence in adult patients with insulin-treated diabetes. Diabetes 42: 341–344
Deary IJ, Hepburn DA, MacLeod KM, Frier BM (1993b) Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia 36: 771–777
Debrah K, Sherwin RS, Murphy J, Kerr D (1996) Effect of caffeine on recognition of and physiological responses to hypoglycemia in insulin-dependent diabetes. Lancet 347: 19–24
Deckert T, Poulsen JE, Larsen M (1978) Prognosis of diabetics with diabetes before the age of thirty-one. 1. Survival, cause of deaths and complications. Diabetologia 14: 363–370
Fanelli C, Pampanelli S, Calderone S, Lepore M, Annibale B, Compagnucci P, Brunetti P, Bolli GB (1995) Effects of recent, short-term hyperglycemia on responses to hypoglycemia in humans. Relevance to the pathogenesis of hypoglycemia unawareness and hyperglycemia-induced insulin resistance. Diabetes 44: 513–519
Fanelli C, Pampanelli S, Lalli C, Del Sindaco P, Ciofetta M, Lepore M, Porcellati F, Bottini P, Di Vincenzo A, Brunetti P, Bolli GB (1997) Long-term intensive therapy of IDDM patients with clinically overt autonomic neuropathy: effects on hypoglycemia awareness and counterregulation. Diabetes 46: 1172–1181
Figlewicz DP, Brot MD, McCall AL, Szot P (1996) Differential gene regulation of CNS noradrenergic and dopaminergic neurons by diabetes. Brain Res 736: 54–60
Fisher BM, Frier BM (eds) (1993) Haemodynamic responses and functional changes in major organs. In: Hypoglycaemia and diabetes: clinical and physiological aspects. Edward Arnold, London, pp 144–155
Frier BM (1993) Hypoglycaemia unawareness. In: Frier BM, Fisher BM (eds) Hypoglycaemia and diabetes: clinical and physiological aspects. Edward Arnold, London, pp 284–301
Fujioka M, Okuchi K, Hiramatsu KI, Sakaki T, Sakaguchi S, Ishii Y (1997) Specific changes in human brain after hypoglycemic injury. Stroke 28: 584–587
Fukuda M, Tanaka A, Tahara Y, Ikegami H, Yamamoto Y, Kumahara Y, Shima K (1988) Correlation between minimal secretory capacity of pancreatic β-cells and stability of diabetic control. Diabetes 37: 81–88
Gerich JE (1988) Glucose counterregulation and its impact on diabetes mellitus. Diabetes 37: 1608–1617
Gerich J, Langlois M, Noacco C, Karam J, Forsham P (1973) Lack of glucagon response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha-cell defect. Science 182: 171–173
Gold AE, MacLeod KM, Deary IJ, Frier BM (1995) Hypoglycemia-induced cognitive dysfunction in diabetes mellitus: effect of hypoglycemia unawareness. Physiol Behav 58: 501–511
Goldgewicht C, Slama G, Papoz L, Tchobroutsky G (1983) Hypoglycaemic reactions in 172 type I (inulin-dependent) diabetic patients. Diabetologia 24: 95–99
Havel PJ, Mundinger TO, Taborsky Jr GJ (1996) Pancreatic sympathetic nerves contribute to increased glucagon secretion during severe hypoglycemia in dogs. Am J Physiol 270: Ego-26
Heller S, Cryer PE (1991) Reduced neuroendocrine and symptomatic responses to subsequent hypoglcemia after one episode of hypoglycemia in non-diabetic humans. Diabetes 40: 223–226
Hepburn DA, Patrick AW, Eadington DW, Ewing DJ, Frier BM (1990) Unawareness of hypoglycaemia in insulin-treated diabetic patients: prevalence and relationship to autonomic neuropathy. Diabet Med 7: 711–717
Hepburn DA, Deary IJ, Frier BM (1992) Classification of symptoms of hypoglycaemia in insulin-treated diabetic patients using factor analysis: relationship to hypoglycaemia unawareness. Diabet Med 9: 70–75
Hepburn DA, McLeod KM, Pell ACH, Scougal IJ, Frier BM (1993) Frequency and symptoms of hypoglycaemia experienced by patients with type 2 diabetes treated with insulin. Diabetic Medicine 10: 231–237
Hirsch IB, Boyle PJ, Craft S, Cryer PE (1991) Higher glycemic thresholds for symptoms during 3-adrenergic blockade in IDDM. Diabetes 4o: 1177–1186
Jennings AM, Wilson RM, Ward JD (1989) Symptomatic hypoglycemia in NIDDM patients treated with oral hypoglycemic agents. Diabetes Care 12: 203–208
Jones TW, Boulware SD, Kraemer DT, Caprio S, Sherwin RS, Tamborlane WV (1991) Independent effects of youth and poor diabetes control on responses to hypoglycemia in children. Diabetes 4o: 358–363
Jones TW, Borg WP, Borg MA, Boulware SD, McCarthy G, Silver D, Tamborlane WT, Sherwin RS (1997) Resistance to neuroglycopenia: an adaptive response during intensive insulin treatment of diabetes. J Clin Endocrinol Metab 82: 1713–1718
Jones TW, Porter P, Sherwin RS, Davis EA, O’Leary P, Frazer F, Byrne G, Stick S, Tamborlane WV (1998) Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 338: 1657–1662
Kendall DM, Teuscher AU, Robertson RP (1997a) Defective glucagon secretion during sustained hypoglycemia following successful islet alto-and autotransplantation in humans. Diabetes 46: 23–27
Kendall DM, Rooney DP, Smets YFG, Salazar BL, Robertson RP (1997b) Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with longstanding type I diabetes and autonomic neuropathy. Diabetes 46: 249–257
Kerr D, Sherwin RS, Pavalkis F, Fayad PB, Sikorski L, Rife F, Tamborlane WV, During MJ (1993) Effect of caffeine on the recognition of and responses to hypoglycemia in humans. Ann Intern Med 119: 799–804
Kleinbaum J, Shamoon H (1983) Impaired counterregulation of hypoglycemia in insulin-dependent diabetes mellitus. Diabetes 32: 493–498
Koh THHG, Eyre JA, Aynsley-Green A (1988) Neonatal hypoglycemia–the controversy regarding definition. Arch Dis Child 63: 1353–1358
Korzon-Burakowska A, Hopkins D, Matyka K, Lomas J, Pernet A, Macdonald I, Amiel S (1998) Effects of glycemic control on protective responses against hypoglycemia in type 2 diabetes. Diabetes Care 21: 283–290
Kumagai AK, Kang YS, Boado RJ, Pardridge WM (1995) Upregulation of blood-brain barrier GLUT1 glucose transporter protein in experimental chronic hypoglycemia. Diabetes 44: 1399–1404
Lingenfelser T, Buettner U, Martin J, Tobis M, Renn W, Kaschel R, Jakober B (1995) Improvement of impared counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM. Diabetes Care 18: 321–325
Liu D, Moberg E, Kollind M, Lin PE, Adamson U, Macdonald IA (1992) Arterial, arterialized venous, venous and capillary blood glucose measurements in normal man during hyperinsulinemic euglycemia and hypoglycemia. Diabetologia 35: 287–290
Marques JL, George E, Peacey SR, Harris ND, MacDonald IA, Cochrane T, Heller SR (1997) Altered ventricular repolarization during hypoglycaemia in patients with diabetes. Diabet Med 14: 648–654
Merimee TJ, Tyson JE (1974) Stabilization of plasma glucose during fasting. N Engl J Med 291: 1275–1278
Mitrakou A, Ryan C, Veneman T, Mokan M, Jenssen T, Kiss I, Durrant J, Creyer P, Gerich J (1991) Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol 260: E67 - E74
Mitrakou A, Fanelli C, Veneman T, Perriello G, Calderone S, Platanisiotis D, Rambotti A, Raptis S, Brunetti P, Cryer P, Gerich J, Bolli G (1993) Reversibility of unawareness of hypoglycemia in patients with insulinomas. N Engl J Med 329: 834–839
Müller UA, Femerling M, Reinauer KM, Risse A, Voss M, Jörgens V, Berger M, Mühlhauser I for the ASD (the Working Group on structured diabetes therapy of the German Diabetes Association) (1999) Intensified treatment and education of type 1 diabetes as clinical routine: a nationwide quality-circle experience in Germany. Diabetes Care 22: B29 - B34
Pardridge WM, Boado RJ, Farrell CR (1990) Brain-type glucose transporter (GLUT-1) is selectively localized to the blood-brain barrier. Studies with quantitative western blotting and in situ hybridization. J Biol Chem 265: 18035–18040
Perros P, Deary IJ, Sellar RJ, Best JJ, Frier BM (1997) Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. Diabetes Care 20: 1013–1018
Popp DA, Tse TF, Shah SD, Clutter WE, Cryer PE (1984) Oral propranolol and metoprolol both impair glucose recovery from insulin induced hypoglycemia in insulin dependent diabetes mellitus. Diabetes Care 7: 243–247
Potter J, Clarke P, Gale EAM, Dave SH, Tattersall RB (1982) Insulin-induced hypoglycaemia in an accident and emergency department: the tip of an iceberg? BMJ 285: 1180–1182
Pramming S, Thorsteinsson B, Stigsby B, Binder C (1988) Glycaemic thresholds for changes in electroencephalograms during hypoglycaemia in patients with insulin dependent diabetes mellitus. BMJ 296: 665–667
Pramming S, Thorsteinsson B, Bendtson I, Binder C (1990) The relationship between symptomatic and biochemical hypoglycaemia in insulin-dependent diabetic patients. J Intern Med 228: 641–646
Pramming S, Thorsteinsson B, Bendtson I, Binder C (1991) Symptomatic hypoglycaemia in 411 Type 1 diabetic patients. Diabet Med 8: 217–222
Reichard P, Pihl M (1994) Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Diabetes 43: 313–317
Reichard P, Nilsson BY, Rosenqvist U (1993) The effect of longterm intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 329: 304–309
Ross RJM (1992) Protocols for common endocrine tests. In: Grossmann A (ed) Clinical endocrinology. Blackwell Scientific Publishers, Oxford, pp 1015–1032
Ryder REJ, Owens DR, Hayes TM, Gathei M, Bloom SR (1990) Unawareness of hypoglycaemia and inadequate glucose counter-regulation: no causal relationship with diabetic neuropathy. BMJ 301: 783–787
Schwartz NS, Clutter WE, Shah SD, Cryer PE (1987) Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest 79: 777–781
Simonson DC, Tamborlane WV, DeFronzo RA, Sherwin RS (1985) Intensive insulin therapy reduces counterregulatory hormone responses to hypoglycemia in patients with type I diabetes. Ann Intern Med 103: 184–190
Stephenson JM, Kempler P, Cavallo-Perin P, Fuller JH (1996) Is autonomic neuropathy a risk factor for diabetes for severe hypoglycaemia? The EURODIAB IDDM complications study. Diabetologia 39: 1372–1376
Tattersall RB, Gill GV (1991) Unexplained deaths of type I diabetic patients. Diabet Med 8: 49–58
Towler DA, Havlin CE, Craft S, Cryer PE (1993) Mechanism of awareness of hypoglycemia: perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes 42: 1791–1798
Uehara Y, Nipper V, McCall AL (1997) Chronic insulin hypoglycemia induces GLUTS protein in rat brain neurons. Am J Physiol 272: E716 - E719
Weir GC, Bonner-Weir S (1990) Islet of Langerhans: the puzzle of interislet interactions and their relevance to diabetes. J Clin Invest 85: 983–987
Whipple AO (1944) Hyperinsulinism in relation to pancreatic tumors. Surgery 16: 89–305
White NH, Skor DA, Cryer PE, Levandoski L, Bier DM, Santiago JV (1983) Indentification of type I diabetic patients at increased risk for hypoglycemia during intensive therapy. N Engl J Med 308: 485–491
Widom B, Simonson DC (1992) Intermittent hypoglycemia im- pairs glucose counter-regulation. Diabetes 41: 1597–1602
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Brückel, J. (2001). Hypoglykämie. In: Böhm, B.O., Palitzsch, KD., Rosak, C., Spinas, G.A. (eds) Klinische Diabetologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59539-4_22
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