Brainstorming in diabetes

Abstract

AbstractThis lecture was given in memory of Dr Arnold Bloom to the 2008 Annual Professional Section Conference of Diabetes UK. In it, the author reviews insights gained by clinical research into the problems of hypoglycaemia unawareness in type 1 diabetes. Novel neuroimaging data suggest that a change in cortical responses to hypoglycaemia may be important to the syndrome of unawareness. Taking the neuroimaging methods into the study of people with insulin resistance suggests that an insulin responsive element of brain glucose metabolism is less insulin sensitive in people with peripheral insulin resistance, and that this ‘ central insulin resistance’ may be particularly evident in brain regions involved in appetite control and reward responses. The lecture concluded with an update of the UK islet transplant programme, now active for people with type 1 diabetes and intractable hypoglycaemia and also those with unstable glucose control after successful renal transplantation. Copyright © 2008 John Wiley & Sons.