Effect of hyperglycemia on CNS

Overview:

Chronic hyperglycemia may results in cerebral metabolic alterations and CNS injury.

Uncontrolled chronic hyperglycemia, resulting from absolute insulin deficiency (type 1 diabetes) or insulin resistance with or withoutinsulin deficiency (type 2 diabetes), is one of the leading causes of diabetic complications in a number of organs. Hyperglycemia-induced (or associated) metabolic and vascular disturbances are known and may increase the risk of strokes, seizures,diabetic encephalopathy and cognitive compromise.

Pathology:

Pathological conditions may result from alterations in cerebral energy homeostasis and metabolism possibly through mechanisms including changes in osmolar gradients in hyperglycemia, hormonal regulation, glucose utilization, oxidative stress and the levels of ketone bodies.

In a study of an animal model of type 1 diabetes significantly increased brain glucose levels and altered the concentration of a number of neurochemicals related to osmotic regulation (e.g., GPC (glycerophosphorylcholine), Ins-myo-inositol, Tau (taurine), ketone bodies e.g., _ HB

(hydroxybutyrate). As hyperglycemia persisted over 4 weeks, levels of additional neurochemicals including GSH and NAA were altered, which suggests increased oxidative stress and deterioration of neuronal integrity.

Hyperglycemia lead to osmolar gradients across cell membranes, triggering alterations in cell volume regulation that shift water from the intracellular fluid space to the extracellular fluid. The osmolargradients due to the elevated glucose levels in hyperglycemia may have led to increased levels of intracellular osmolytes including GPC, Ins and Tau to promote the maintenance of neuronal and glial cell volume. Glycemic normalization was able to restore the GSH(Glutathione) level but not that of NAA (N-Acetyl-L-aspartate), indicating potential irreversible neuronal damage due to prolonged hyperglycemia.

Sign and symptom:

Living and management:

Living with chronic hyperglycemia is a very hard thing for most of the patients that are suffering from it especially the children, in which they struggle a lot with the diet restrictions that was placed in order to protect them from the exaggerated complications of hyperglycemia, and because kids are kids don’t understand the seriousness of the condition! As for the elderly, it is much easier to control dietary intake of sugar because they themselves know what’s the best for their health is.

In term of medications to lower the sugar levels in the blood has also the same scenario as dietary restrictions!

Diagnosis:

Doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.

The doctor will check:

1- Overall muscle strength and tone

2- Tendon reflexes

3- Sensitivity to touch and vibration

Along with the physical exam, doctor may perform or order specific tests to help diagnose diabetic neuropathy, such as:

1- Filament test

2- Sensory testing

3- Nerve conduction testing

4- Muscle response testing

5- Autonomic testing

Treatment:

• Get physical
• Take your medication as directed
•  Follow your diabetes eating plan
•  Check your blood sugar
•  Adjust your insulin doses to control hyperglycemia