Does Central Nervous System Adaptation to Antecedent Glycemia Occur in Patients with Insulin-Dependent Diabetes Mellitus?

Excerpt

Glucose derived from the circulation is the predominant metabolic fuel used by the central nervous system under most physiologic conditions. Hypoglycemia causes brain dysfunction (neuroglycopenia) and can cause brain death, because it deprives the central nervous system neurons of this critical fuel. Thus, it is not surprising that effective glucose counterregulatory mechanisms evolved. Indeed, in all persons except those who use drugs that lower the plasma glucose concentration, hypoglycemia is an unusual clinical event.

The prevention or correction of hypoglycemia is normally the result of both dissipation of insulin and activation of glucose counterregulatory systems (1, 2). Insulin suppresses hepatic