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Hypoglykämien und zentrales Nervensystem

Hypoglycemia and the central nervous system

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Zusammenfassung

Aufgrund seines hohen Glukosebedarfs ist das menschliche Gehirn gegenüber Hypoglykämien sehr vulnerabel. Im Rahmen einer akuten Hypoglykämie kommt es bei Blutglukosewerten <2,78 mmol/l (<50 ml/dl) zu Bewusstseinsstörungen bis hin zum Koma und zu Krampfanfällen. Zerebrale Regulationsmechanismen tragen nach rezidivierenden Hypoglykämien zur Ausbildung einer Hypoglykämiewahrnehmungsstörung bei. Jede schwere Hypoglykämie mit Symptomen der Neuroglukopenie kann das Gehirn nachhaltig schädigen. Das Ausmaß, an dem Hypoglykämien an der Verdoppelung des Demenzrisikos bei Menschen mit Diabetes ursächlich beteiligt sind, ist nicht eindeutig zu bestimmen. Bei Typ-1-Diabetes-Patienten führen eher Hyper- als Hypoglykämien zu kognitiven Beeinträchtigungen; in Längsschnittuntersuchungen fand sich bis ins mittlere Lebensalter keine eindeutige kognitive Beeinträchtigung durch rezidivierende Hypoglykämien. Dies schließt nicht aus, dass erst im späteren Lebensalter eine erhöhte Demenzrate resultieren könnte. Bei älteren Typ-2-Diabetes-Patienten besteht ein bidirektionaler Zusammenhang zwischen Typ-2-Diabetes und Demenz: Schwere Hypoglykämieepisoden erhöhen wahrscheinlich das Risiko kognitiver Defizite, und gleichzeitig erhöhen kognitive Defizite bei älteren Typ-2-Diabetes-Patienten das Risiko für schwere Hypoglykämien.

Abstract

Due to its high energy demand the human brain is extremely vulnerable to hypoglycemia and below a blood sugar threshold of 2.78 mmol/l (50 mg/dl) impairment of consciousness and seizures occur. After recurrent episodes of hypoglycemia, changes in the counter regulation of cerebral processed hypoglycemia appear which are responsible for the development of disturbances in the perception of hypoglycemia. The causal role of hypoglycemia episodes for a doubling of the dementia rate in type 1 and type 2 diabetes cannot clearly be determined. In type 1 diabetes hyperglycemia is more responsible for cognitive impairment than hypoglycemia. Long-term studies did not identify hypoglycemia-related cognitive deterioration until the midlife decade; however, it cannot be excluded that the dementia risk in old age is increased. In type 2 diabetes there exists a bidirectional relationship between hypoglycemia and dementia: severe recurrent episodes of hypoglycemia increase the risk of cognitive impairment and simultaneously, cognitive dysfunction increases the risk of hypoglycemia episodes.

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  1. Klinik für Neurologie, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland

    F. Erbguth

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Erbguth, F. Hypoglykämien und zentrales Nervensystem. Diabetologe 9, 25–32 (2013). https://doi.org/10.1007/s11428-012-0911-4

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