Ryan C M, Atchison J, Puczynski S, Puczynski M, Arslanian S, Becker D
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania.
J Pediatr. 1990 Jul;117(1 Pt 1):32-8. doi: 10.1016/s0022-3476(05)82440-0.
To assess the effects of mild hypoglycemia on cognitive functioning in diabetic children, we used an insulin glucose clamp technique to induce and maintain a hypoglycemic state. Eleven patients, 11 to 18 years of age, completed a series of cognitive tests during a baseline euglycemic state (100 mg/dl (5.5 mmol/L] and repeated those measures at the beginning and end of a hypoglycemic plateau (55 to 65 mg/dl (3.1 to 3.6 mmol/L], and again at restoration of euglycemia. At plasma glucose levels of 60 to 65 mg/dl (3.3 to 3.6 mmol/L), a significant decline in mental efficiency was found. This was most apparent on measures of mental "flexibility" (Trial Making Test) and on measures that required planning and decision making, attention to detail, and rapid responding. Moreover, complete recovery of cognitive function was not contemporaneous with restoration of euglycemia, particularly on those tests requiring rapid responding and decision making (choice reaction time). Not all subjects showed evidence of cognitive impairment during hypoglycemia. The very high degree of intersubject variability suggests that, in addition to plasma glucose values, unknown physiologic variables are responsible for triggering cognitive impairments in school-aged youngsters with diabetes during an episode of mild hypoglycemia.
为评估轻度低血糖对糖尿病儿童认知功能的影响，我们采用胰岛素 - 葡萄糖钳夹技术诱导并维持低血糖状态。11名年龄在11至18岁的患者在基线血糖正常状态（100毫克/分升[5.5毫摩尔/升]）下完成了一系列认知测试，并在低血糖平台期（55至65毫克/分升[3.1至3.6毫摩尔/升]）开始和结束时以及血糖恢复正常时重复这些测量。在血浆葡萄糖水平为60至65毫克/分升（3.3至3.6毫摩尔/升）时，发现心理效率显著下降。这在心理“灵活性”测量（连线测验）以及需要计划和决策、关注细节和快速反应的测量中最为明显。此外，认知功能的完全恢复与血糖恢复正常并不同时发生，特别是在那些需要快速反应和决策的测试（选择反应时间）中。并非所有受试者在低血糖期间都有认知障碍的迹象。受试者之间的高度变异性表明，除了血浆葡萄糖值外，未知的生理变量也导致学龄期糖尿病青少年在轻度低血糖发作期间引发认知障碍。
