Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes

Abstract

OBJECTIVE -To examine the effects of acute hyperglycemia on cognitive function and mood in people with type 2 diabetes.RESEARCH DESIGN AND METHODS -Twenty subjects with type 2 diabetes, median age 61.5 years (range 53.1-72.0), known duration of diabetes 5.9 years (range 2.8 -11.2), BMI 29.8 kg/m 2 (range 22.0 -34.6), and HbA 1c 7.5% (range 6.7-8.4) were studied. Treatment modalities varied from antidiabetic medications to insulin. A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose at either 4.5 (euglycemia) or 16.5 mmol/l (hyperglycemia) on two occasions in a randomized and counterbalanced fashion. Tests of information processing, immediate and delayed memory, working memory, and attention were administered, along with a mood questionnaire, during each experimental condition.RESULTS -Speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hyperglycemia, with reduced energetic arousal and increased sadness and anxiety.CONCLUSIONS -During acute hyperglycemia, cognitive function was impaired and mood state deteriorated in a group of people with type 2 diabetes. These findings are of practical importance because intermittent or chronic hyperglycemia is common in people with type 2 diabetes and may interfere with many daily activities through adverse effects on cognitive function and mood. Diabetes Care 27:2335-2340, 2004D iabetes is associated with rapid fluctuations in blood glucose. Hyperglycemia is a frequent consequence of the relative or absolute insulin deficiency that is intrinsic to diabetes, and hypoglycemia is a common side effect of treatment with insulin and some antidiabetic medications (1). Because the brain is dependent on a continuous supply of glucose as its principal source of energy, changes in blood glucose concentration rapidly affect cerebral function. The adverse effects of acute hypoglycemia on cognitive function and on mood are recognized (2,3). However, less is known about the effects of acute hyperglycemia on cerebral function. Anecdotal descriptions by patients with diabetes suggest that when blood glucose is elevated, changes in mood (such as increased irritability and feelings of diminished wellbeing) occur and rapid thinking is more difficult.Published data on the effects of acute hyperglycemia on cognitive function are contradictory. Two studies (4,5) have demonstrated impaired language skills and reduced IQ during hyperglycemia compared with euglycemia. Other studies have shown no effect of acute hyperglycemia on cognitive function (6 -8) or mood (9). However, in the study by Gschwend et al. (6), only two tests were used to assess cognitive function, and in the studies by Draelos et al. (8) and Weinger et al. (9) the study cohorts had chronically poor metabolic control, which may have allowed cerebral adaptation to occur in response to prevailing high blood glucose concentrations. A further study by Sindrup et al. (10) showed that short-term...

Better cognitive performance following a low-glycaemic-index compared with a high-glycaemic-index carbohydrate meal in adults with type 2 diabetes

“…Comparable cognitive performance decrements, including executive function, but a lack of change in other cognitive domains such as sustained attention and immediate verbal recall were observed in this study following the high-vs low-GI carbohydrate meal compared with the decrements reported by Sommerfield and colleagues, where similar levels of blood glucose were attained using a hyperglycaemic/hyperinsulinaemic clamp [5]. Collectively, these results support an argument that more robust hyperglycaemia-induced decrements are apparent in more complex tasks [5].…”

“…Increasingly evident is that transient periods of hyperglycaemia may be detrimental to cognitive performance in [4][5][6], with this study demonstrating that meal-induced changes in blood glucose are of sufficient magnitude to affect performance adversely. Admittedly, performance following pasta or bread consumption, compared with performance on water days, did not provide a consistent pattern of benefit following pasta consumption and decrement following bread intake.…”

“…Additionally, undesirable and transient excursions in blood glucose and/or insulin levels, secondary to insulin therapy-induced hypoglycaemia, and experimentally produced hyperglycaemia decrease cognitive function [3]. Specifically, acute hyper-glycaemic episodes in adults with type 2 diabetes, associated with either ingestion of 50 g of carbohydrate as a high-glycaemic-index (GI) food [4] or implementation of a hyperinsulinaemic/hyperglycaemic clamp [5], result in transitory cognitive dysfunction. Even normal fluctuations in the degree of hyperglycaemia experienced throughout the day in adults with type 2 diabetes appears to have a negative impact on cognitive tasks [6].…”

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Investigation of the effectiveness in the reduction of pain EMLA cream intramuscular cephalosporin in the application

“…Additionally, quick or slow administration of drug affects the pain. Recommended administration time for 1 ml drug is 10 seconds [5][6][7][8][9][10]. Quick administration of drug increases the level of pain.…”