Type1diabetes, Hypoglycemia Unawareness
Conditions
Brief summary
It is thought that altered brain lactate handling is involved in the development of impaired awareness of hypoglycemia (IAH), i.e. the inability to timely detect hypoglycemia in people with type 1 diabetes (T1DM). Infusion of lactate diminishes symptomatic and hormonal responses to hypoglycemia in patients with normal awareness of hypoglycemia (NAH), resembling the situation of patients with IAH. It is unknown whether this attenuating effect is due to brain lactate oxidation or the result of lactate-induced alterations of global and regional cerebral blood flow (CBF). Normally, hypoglycemia causes a redistribution of CBF towards the thalamus, from where the sympathetic response to hypoglycemia is coordinated, but in IAH this effect is absent and global CBF is increased. We hypothesize that lactate infusion in patients with NAH will result in blunting of thalamic activation and/or enhanced global CBF. If so, these results may help delineating the pathogenesis of IAH which eventually creates new avenues to protect against the morbidity associated with hypoglycemia and IAH. Study design: Single-blind placebo controlled, randomized cross-over intervention study Study population: T1DM patients with NAH (n=10) Intervention: On two separate occasions, patients with T1DM and NAH will undergo a hyperinsulinemic euglycemic-hypoglycemic glucose clamp with or without the infusion of exogenous lactate. ASL-MRI will be applied to measure global and regional changes in CBF. Main study parameters/endpoints: The change in regional thalamic CBF in response to intravenous lactate infusion compared to placebo, during hypoglycemia
Interventions
DRUGSodium Lactate
IV infusion
DRUGSodium chloride
IV infusion
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Diabetes duration ≥ 1 year * Age: 18-50 years * Body-Mass Index: 18-30 kg/m2 * HbA1c: 42-75 mmol/mol (6-9%) * Outcome Clarke questionnaire: 0-1 * Blood pressure: \<160/90 mmHg
Exclusion criteria
* Inability to provide informed consent * Use medication other than insulin, except for oral contraceptives or stable thyroxin supplementation therapy * Presence of any other medical condition that might interfere with the study protocol, such as brain injuries, epilepsy, a major cardiovascular disease event or cardiac failure, known liver disease, anxiety disorders or a history of panic attacks. * Microvascular complications of T1DM: Proliferative retinopathy, symptomatic diabetic neuropathy (including autonomic neuropathy) or Nephropathy; clinical/overt albuminuria or an estimated glomerular filtration rate \<60ml/min/1.73m2. * MRI contraindications (pregnancy, severe claustrophobia, metal parts in body)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Regional CBF in ml/100g/min measured with ASL-MRI | during stable euglycemia (40 minutes) and hypoglycemia (45 minutes) | The change in regional thalamic CBF in response to intravenous lactate infusion compared to placebo, during hypoglycemia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global CBF in ml/100g/min measured with ASL-MRI | during stable euglycemia (40 minutes) and hypoglycemia (45 minutes) | The change in global CBF in response to intravenous lactate infusion |
| Counterregulatory hormone responses to hypoglycemia | during stable euglycemia (40 minutes) and hypoglycemia (45 minutes) | The difference in adrenaline (pmol/L) responses to hypoglycemia during lactate infusion compared to placebo |
| Symptom responses to hypoglycemia | during stable euglycemia (40 minutes) and hypoglycemia (45 minutes) | The difference in symptom responses to hypoglycemia (meausured with a validated questionnaire) during lactate infusion compared to placebo |
| Measurements of metabolites in cell lysates or supernatants of the cultured immune cells | during stable euglycemia (40 minutes) and hypoglycemia (45 minutes) | The effect of lactate administration on immune cell function and metabolism |
Countries
Netherlands
Contacts
Primary ContactBastiaan de Galan, PhD
Outcome results
None listed