Hypoglykämien und Gehirn

ZUSAMMENFASSUNG

Aufgrund seiner energetischen Abhängigkeit von der direkten Glukosezufuhr ist das menschliche Gehirn gegenüber Hypoglykämien sehr vulnerabel. Schwere Hypoglykämien führen zu Bewusstseinsstörungen, schlaganfallähnlichen fokalen motorischen Symptomen und Krampfanfällen. Akute Funktionsstörungen können bei schwerer hypoglykämischer Exposition in irreversible neuronale Zellschädigungen übergehen. Zerebrale Regulationsmechanismen tragen nach rezidivierenden Hypoglykämien zur Ausbildung einer Hypoglykämie-Wahrnehmungsstörung bei, die das Risiko schwerer Hypoglykämien weiter erhöht. Bei Typ-1-Diabetespatienten konnten bis ins mittlere Lebensalter keine negativen kognitiven Auswirkungen vermehrter Hypoglykämien bewiesen werden, allerdings ist offen, ob sich diese möglicherweise erst in höherem Lebensalter manifestieren. Bei Typ-2-Diabetespatienten bestehen bi- oder sogar tridirektionale kausale Zusammenhänge zwischen eingeschränkter Kognition, Hypoglykämien und einer schlechten glykämischen Kontrolle.

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