Elsevier

The Lancet

Volume 343, Issue 8888, 1 January 1994, Pages 16-20
The Lancet

Articles
Protection by lactate of cerebral function during hypoglycaemia

https://doi.org/10.1016/S0140-6736(94)90876-1Get rights and content

Abstract

Severe hypoglycaemia with brain dysfunction limits intensified therapy in patients with insulin-dependent diabetes mellitus, despite evidence that such therapy reduces the risk of chronic complications of the disease. We have investigated the effect of infusing lactate (a potential non-glucose fuel for brain metabolism) on protective, symptomatic neurohumoral responses and on brain function during hypoglycaemia in seven healthy men. Elevation of lactate (within a physiological range) substantially diminished catecholamines, growth hormone, cortisol, and symptomatic responses to hypoglycaemia and lowered the glucose level at which these responses began. Glucagon responses were unaffected. Lactate was also associated with a significant lowering of the glucose level at which brain function deteriorated, suggesting that brain function was protected during the hypoglycaemia. The defect in counter-regulation is similar to that seen in hypoglycaemia-prone diabetic patients. Initiation of the protective responses to hypoglycaemia (except glucagon) can be delayed by supporting metabolism with an alternative metabolic fuel. Cerebral cortical dysfunction of severe hypoglycaemia is also delayed. Our demonstration that higher brain function can be protected during hypoglycaemia may have therapeutic potential.

References (29)

  • D. Liu et al.

    Arterial, arterialised venous and venous and capillary blood glucose measurements in normal man during hyperinsulinaemic euglycaemia and hypoglycaemia

    Diabetologia

    (1992)
  • A. Maran et al.

    Lack of protection of cerebral function in well-controlled diabetic patients with hypoglycemia unawareness

    Diabetes

    (1993)
  • A. Maran et al.

    Double blind clinical and laboratory study of hypoglycaemia with human and porcine insulin in diabetic patients reporting hypoglycaemia unawareness after transferring to human insulin

    BMJ

    (1993)
  • Da Hepburn et al.

    Symptoms of acute insulin-induced hypoglycemia in humans with and without IDDM: factor-analysis approach

    Diabetes Care

    (1991)
  • Cited by (210)

    • Glucose and Perinatal Brain Injury-Questions and Controversies

      2018, Neurology: Neonatology Questions and Controversies
    • Lactate and its many faces

      2016, European Journal of Paediatric Neurology
      Citation Excerpt :

      The negative connotation of lactate can easily be understood from everyday clinical practice, since increases of serum or tissue lactate concentrations are often encountered and generally associated with severe disease states or poor outcome.1 Interestingly, however, in the last decades, a more beneficial side of lactate as an alternative 'glucose sparing' fuel of the brain has also been demonstrated.2–6 Experimental and clinical research shows that lactate can be used as an alternative fuel for brain metabolism in circumstances of a low brain glucose.7

    View all citing articles on Scopus
    View full text