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Type I Diabetes, highs and lows

effect on the brain
research paper
by
Carol Ann Hawk

Psy1010-302-Su17
Michael Steele
07/28/2017

In this research paper, it will look at how hyperglycemia and hypoglycemia affect

Type One diabetics brains and how behavioral medicine is growing as an aspect in diabetes
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care. First lets define what Type I diabetes, hyperglycemia, and hypoglycemia are. Type I

Diabetes is an autoimmune disease where the immune system starts to attack the Insulin

hormone producing Beta cells located in the pancreas gland, which stops Insulin production.

Insulin is a hormone that helps regulate the glucose in blood. Blood sugar levels in Type I

diabetics can become hypoglycemic, low blood sugar and hyperglycemic, high blood sugar. Type

I diabetics have many factors that go into managing their disease. Some in the diabetic

community have compared it to 24/7 job with no benefits or vacation. It can be a financial,

mental and physical burden. People diagnosed with Type I diabetes are more prone to suffer

from depression.

Hyperglycemia is when the patients blood sugar is above the 300 milligrams per

deciliter or mg/dl and hypoglycemia is when blood sugar drops below 70 mg/dl. Symptoms of

Hypo blood sugar levels are: blurred vision, shaking, sweating, dizziness, hunger, rapid heart rate

and fatigue. Other signs includes: pale skin, mood changes, trouble thinking clearly, loss of

conscious and seizure or coma. Symptoms of Hyper blood sugar levels is excessive urination,

extreme thirst and hunger, risk of ketones, slowing the healing of cuts and wounds, dry itchy

skin, irritability, headaches, blurred vision, and tiredness.

In the article of Regional Brain Volume Differences Associated With Hyperglycemia

and Severe Hypoglycemia in Youth With Type 1 Diabetes is written by Dana C. Perantie, Jenny

Wu, Jonathan M. Koller, Audrey Lim, Stacie L. Warren, Kevin J. Black, MD, Michelle Sadler,

RN, BSN, CDE, Neil H. White, MD, CDE, Tamara Hershey, PHD. The authors discuss the

effects of hyperglycemia and hypoglycemia in Type I diabetics youths brains. Studies have

found that exposure to high and low blood sugars may alter regions in the brain of diabetics. The

authors used MRI and VBM technology to look at if high and low blood sugars have an effect on
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gray or white matter in adolescent Type I diabetic brains. (p. 2331) The study used 108 Type I

diabetic youths with 51 healthy control subjects. The results of the study did not find any

significant differences between the control or diabetic youths in gray or white matter, but did

find that the diabetic group proportionally more left handed and ambidextrous subjects. (p. 2332)

Hypoglycemia, the authors acknowledge that their diabetic subjects had little to no

episodes of low blood sugar, so the distribution of severe hypoglycemic episodes were skewed.

They did find that the any hypoglycemia group to the no hypoglycemia group, the any

hypoglycemia group had less gray matter volume in the left superior temporal/occipital cortex

(P0.001) and left inferior occipital cortex (P0.0002). No differences were found comparing the

healthy control group to the no hypo group or the any hypo group. The overall results found that

low blood sugars can affects the gray matter in the left temporal-occipital junction, episodic

memory, their data strongly suggests that hypoglycemic episodes affect the left side more than

the right side. Hyperglycemia, the authors report that high hyperglycemic exposure correlated

with less grey matter volume in the right cuneus and precuneus (P 0.02). High blood sugar

episodes also found with larger grey matter volume in the right frontal middle gyrus (P 0.008).

They also found in the right superior parietal less white matter volume (P 0.01). The overall

results found that hyperglycemic exposure associated with visuospatial function, episodic

memory, a degree of early vascular changes in brain, greater gray matter in right prefrontal

region, possible cognitive performance loss in posterior parietal white matter. (p. 2333-2335)

The authors propose that because the regional volume differences found in the study and

in animal models, hypoglycemia has been shown to cause neuronal death and dysfunction.

Hyperglycemia induces injury to myelin and neurons. The authors acknowledge that because of
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the study being correlative and retrospective, it can not be ruled out that the differences were

already present before high or low blood sugar episodes. (p. 2336)

In the journal article in Journal of Counseling and Clinical Psychology, Diabetes and

Behavioral Medicine: The Second Decade by Linda A. Gonder-Frederick, Daniel J. Cox, and

Lee M. Ritterband written in 2002, the authors suggest that an integrated medical and mental

treatment for patients affected by Type I and Type II diabetes. In 1993 the National Institutes of

Health funded the Diabetes Control and Complications Trial research group (DCCT). The

authors point out that biggest problem to overcome when it came to Diabetic treatment was

mental health which is why providers turned to behavioral psychologists for aid. When the years

of the 2000s hit, the impact of including the behavioral aspect can be observed in all treatments.

(p. 611)

The authors explain that patients who suffer from diabetes require a constant level of

monitoring to regulate their health. Diabetes management relies on a complex behavior of self

monitoring and self regulating of complying to strict regimen of diet, exercise and medication.

Self treatment and making informed choice about their health is emphasized in treatments for the

disease. The authors claim that its fine to have an independence over positive medical related

outcomes, but with that come negative ones, such as self blame for negative outcomes of their

health. (p.613)

With Psychological and Psychopathology distresses, the authors report clinical

depression, eating disorders, anxiety disorder, phobia of needles and self testing, social

withdrawal, and diabetes burnout. The physical reasons for why psychiatric problems have not

yet been determined, but studies show that the disease of diabetes is a risk factor for growing

mental health issues in all age groups. (p. 613-616) The authors demonstrate why
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endocrinologists and psychologists can benefit diabetic patients by working together and

developing new treatments to help with the mental distress of diabetes.

Type I diabetes is a mentally and physically exhausting condition. The research of these

two topics conclude that it is very important to combine the medical and mental treatments for

Type I diabetes patients. Hyperglycemia and hypoglycemia are both serious as potential harm to

brain and emotional state. While there have been no studies found of psychiatric problems linked

to the brain in diabetics, it is something to learn and benefit from in future studies.
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WORKS CITED
.
Gonder-Frederick, L. A., Cox, D. J., & Ritterband, L. M. (2002). Diabetes and behavioral
medicine: the second decade. Journal of consulting and clinical psychology, 70(3), 611.

Perantie, D. C., Wu, J., Koller, J. M., Lim, A., Warren, S. L., Black, K. J., ... & Hershey, T.
(2007). Regional brain volume differences associated with hyperglycemia and severe
hypoglycemia in youth with Type I diabetes. Diabetes care, 30(9), 2331-2337.