Abstract
This paper provides an overview of insulin-induced hypoglycemia as a triggering factor of cognitive deficit in children with type 1 diabetes mellitus. For this purpose, databases from 1961 to 2013 were used with the objective of detecting the primary publications that address the impact of hypoglycemia on cognitive performance of diabetic children. The results obtained from experimental animals were excluded. The majority of studies demonstrated that the cognitive deficit in diabetic children involves multiple factors including duration, intensity, severity, and frequency of hypoglycemia episodes. Additionally, age at the onset of type 1 diabetes also influences the cognitive performance, considering that early inception of the disease is a predisposing factor for severe hypoglycemia. Furthermore, the results suggest that there is a strong correlation between brain damage caused by hypoglycemia and cognitive deterioration. Therefore, a more cautious follow-up and education are needed to impede and treat hypoglycemia in children with diabetes mellitus.
Highlights
The main objective in treatment of diabetes is to reach glycemic values which are the closest possible to those found in nondiabetic patients
It is necessary to analyze each case carefully, aiming at establishing the participation of factors related to hypoglycemia in the development of cognitive deficit, especially in children submitted to insulin therapy, since they are more susceptible to hypoglycemia
It is not the focus of this review, another variable to be considered is the possibility of hypoglycemic episodes occurring within a context of hyperglycemia resulting from inappropriate insulin treatment, since it must be considered that acute [119, 120] and chronic [121,122,123,124] hyperglycemia, gestational hyperglycemia [125], and glycemic variability [126, 127] can contribute towards the reduction of cognitive performance, since the excess of glucose can lead to brain damage regardless of the occurrence of Insulin-Induced Hypoglycemia (IIH) [128]
Summary
The main objective in treatment of diabetes is to reach glycemic values which are the closest possible to those found in nondiabetic patients. If there is no correction, there may be increased frequency, intensity, and duration of hypoglycemia considering that the return of perception depends on the appearance of a glycemic value lower than when the previous episode occurred [13]. Another important aspect related to loss of perception of hypoglycemia is the possibility that the patients with a better control of their. It is necessary to analyze each case carefully, aiming at establishing the participation of factors related to hypoglycemia in the development of cognitive deficit, especially in children submitted to insulin therapy, since they are more susceptible to hypoglycemia
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