Providing the brain with lactate and potentially other fuels may protect diabetics against life-threatening bouts of hypoglycemia, a Yale study has found. The study appears in the Journal of Clinical Investigation.
Both type 1 and type 2 diabetics must tightly control their blood glucose levels to prevent long-term complications of the disease. But the intensive daily regimen of insulin that is required may often result in severe episodes of hypoglycemia, or dangerously low blood sugar levels. Such episodes may occur without warning or during sleep, and can lead to brain damage, cognitive impairment, or even death.
The Yale team investigated alternates to glucose as fuel sources for the brain to find out if they can help diabetics achieve the necessary tight glycemic control. They infused rodents with lactate and measured levels of indicative chemicals in their brains.
Their results show that lactate helped the animals maintain normal levels of glucose during bouts of hypoglycemia, and helped reverse symptoms associated with acute hypoglycemic attacks.
There may be implications in this study for human diabetics. “Our findings help us understand how brain energy metabolism is altered in the context of hypoglycemia,” explained first author Raimund Herzog, assistant professor of endocrinology at Yale School of Medicine. “This study will now guide us in the design of therapies that protect the brain from hypoglycemic injury, thereby permitting tighter control of glucose levels via intensive insulin treatment.”
Other authors are co-first author Lihong Jiang, and Peter Herman, Chen Zhao, Basavaraju Sanganahalli, Graeme Mason, Fahmeed Hyder, Douglas Rothman, Robert Sherwin, and Kevin Behar of Yale School of Medicine.
This study was supported by grants from the National Institutes of Health (NIDDK R01DK027121, R01 DA021785, R21 AA018210, R21 AA019803 and ARRA supplement R01 DK027121-28S, NCATS UL1 RR024139, NINDS R01 NS037527, NIDDK R37 DK20495, NINDS 1 P30 NS052519 and NIDDK K08 DK082618), the Juvenile Diabetes Research Foundation (JDRF 4-2010-433), and by a YCCI Scholar award.
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