Diabetes increases brain damage caused by severe hypoglycemia

1 Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine; and 2 Department of Cell Biology and Physiology, Washington University, St. Louis, Missouri Submitted 31 December 2008 ; accepted in final form 2 May 2009 Insulin-induced severe hypoglycemia causes brain damage. The hypothesis to be tested was that diabetes portends to more extensive brain tissue damage following an episode of severe hypoglycemia. Nine-week-old male streptozotocin-diabetic (DIAB; n = 10) or vehicle-injected control (CONT; n = 7) Sprague-Dawley rats were subjected to hyperinsulinemic (0.2 U·kg –1 ·min –1 ) severe hypoglycemic (10–15 mg/dl) clamps while awake and unrestrained. Groups were precisely matched for depth and duration (1 h) of severe hypoglycemia (CONT 11 ± 0.5 and DIAB 12 ± 0.2 mg/dl, P = not significant). During severe hypoglycemia, an equal number of episodes of seizure-like activity were noted in both groups. One week later, histological analysis demonstrated extensive neuronal damage in regions of the hippocampus, especially in the dentate gyrus and CA1 regions and less so in the CA3 region ( P < 0.05), although total hippocampal damage was not different between groups. However, in the cortex, DIAB rats had significantly (2.3-fold) more dead neurons than CONT rats ( P < 0.05). There was a strong correlation between neuronal damage and the occurrence of seizure-like activity ( r 2 > 0.9). Separate studies conducted in groups of diabetic ( n = 5) and nondiabetic ( n = 5) rats not exposed to severe hypoglycemia showed no brain damage. In summary, under the conditions studied, severe hypoglycemia causes brain damage in the cortex and regions within the hippocampus, and the extent of damage is closely correlated to the presence of seizure-like activity in nonanesthetized rats. It is concluded that, in response to insulin-induced severe hypoglycemia, diabetes uniquely increases the vulnerability of specific brain areas to neuronal damage. Fluoro-Jade; insulin; seizure; streptozotocin Address for reprint requests and other correspondence: S. Fisher, Div. of Endocrinology, Metabolism, & Lipid Research, Washington University in St. Louis, Campus Box 8127, 660 South Euclid Ave., St. Louis, MO 63110 (e-mail: sfisher{at}dom.wustl.edu )