King’s research uncovers new links between diabetes and the brain

Around 400,000 people are currently living in the UK with type 1 diabetes. The condition can involve periods of dangerously high (hyperglycemia) or dangerously low (hypoglycaemia) blood sugar levels because the body can’t regulate levels by itself.

Many people with type 1 diabetes can control their condition by recognising early symptoms of a change in blood sugar levels – dizziness, trembling and blurred vision – and taking actions like eating sugary snacks. But, around 1 in 10 can’t pick up these warning signs, leaving them at increased risk of dangerously low blood sugar levels that can lead to unconsciousness and even death.

Researchers at King’s have now discovered the areas of the brain that affect whether a person has an inability to pick up these warning signs, known as Impaired Awareness of Hypoglycaemia (IAH). This discovery will allow the development of treatments that target the area and recover awareness of symptoms, possibly saving lives.

Professor Stephanie Amiel and colleagues studied men with type 1 diabetes some of whom suffered from IAH and some who didn’t. They monitored changes in brain activity during periods of healthy blood sugar levels, induced hypoglycaemia and then recovery.

They found that men with IAH showed significantly less activity in specific areas, particularly regions associated with subjective awareness, emotional experience, aversiveness and memory. The results suggested that not only are people with IAH unable to recognise the symptoms of hypoglycaemia but they are also unable to recall previous episodes as particularly unpleasant or disturbing.

The team have now begun a trial of a novel treatment that could help those experiencing IAH by not only targeting key areas of the brain but also working on the emotional and cognitive elements of these patients’ responses.

Professor Amiel says: ‘Severe hypoglycaemia is a life-threatening emergency and it, with IAH, can be devastating for people with type 1 diabetes and for their families. The brain imaging studies have helped us understand why about 1 in 10 people with type 1 diabetes struggle so much with problematic hypoglycaemia and have underpinned a research programme that has led us to a novel treatment with exciting potential to help these people. It may also have implications for other conditions where failure to experience symptoms leads people to recurrent severe exacerbations of disease.’