New Biomarker developed to detect life threatening Hypoglycemia

A new study published in the journal Acta Diabetologica has revealed that a novel biomarker (glial acetate metabolism), might be helpful in the creation of a diagnostic tool for hypoglycemia-associated autonomic failure (HAAF).

The study is significant as currently, no objective diagnostic tool exists for this condition, which if not treated, could lead to ever-worsening or possibly life-threatening episodes of dangerously low blood sugar levels.

Prior exposure to insulin-induced hypoglycemia was shown to increase glial acetate metabolism (GAM) during subsequent exposure to hypoglycemia in diabetic individuals. However, it remained unclear whether this effect was dependent on the disease state or the antecedent cause of hypoglycemia. David Harry McDougal, Pennington Biomedical Research Center, Baton Rouge, U.S, and colleagues conducted the study to establish whether exposure to fasting-induced hypoglycemia was sufficient to produce alterations in GAM in non-diabetic individuals.

Hypoglycemia (low blood sugar) is a major complication of type 1 and type 2 diabetes. Diabetic people often face difficulty in self-administering the exact insulin dose at the correct time in order to keep their blood sugar levels within a healthy range. A range of symptoms including dizziness, headaches, and nausea are experienced by an individual during a hypoglycemic episode that triggers them to seek immediate, potentially life-saving, medical care.

Also Read: New tool developed for identifying diabetes patients with high risk of hypoglycemia

In case of too many hypoglycemic episodes, senses may become blunted. The patients might stop experiencing the physical symptoms that serve as cues to seek medical attention. They may not even realize they are having one or multiple hypoglycemic episodes until it is too late. This condition is more commonly known as HAAF.

Blood glucose is the brain's essential metabolic fuel. If glucose isn't available because a person has hypoglycemia, the brain can adapt by increasing the rate at which it uses alternative energy sources, such as acetate.

"The results of our study suggest that this adaptation may still be present after exposure to times of low blood sugar and therefore can be used to measure how frequently a person experiences low blood sugar," Dr. McDougal said. "We believe that by measuring how well a person's brain uses acetate, we might one day be able to determine if they are suffering from HAAF or are at increased risk for developing the condition in the near future."

This would allow doctors to provide treatment for reducing this risk by changing the medication the person takes or advising them to use a continuous glucose monitoring device, Dr. McDougal said.

For the study, GAM was measured via carbon-13 magnetic resonance spectroscopy during infusion of [1-¹³C] acetate before and after a 72-h fast in six metabolically healthy men aged 18–40 years. The main outcome measure was the percent enhancement of cerebral [1-¹³C] bicarbonate (the primary metabolic byproduct of glial oxidation of [1-¹³C] acetate). Continuous glucose monitoring was used to measure hypoglycemic episodes during the 72-h fast.

Key Findings:

• 72 h of fasting significantly reduced blood glucose levels and resulted in a high frequency of hypoglycemic episodes.


• Steady-state GAM increased from 53.5 ± 3.7 to 61.9 ± 1.7% following the 72-h fast. This increase correlated with greater duration of hypoglycemia experienced during the fast.


• Subjects with greater GAM at baseline experienced a greater increase in the duration of hypoglycemia experienced during the 72-h fast.

"There is currently no objective way for a health care provider to measure whether a patient has experienced repeated episodes of low blood sugar and therefore may be suffering from HAAF," said McDougal. One-third of older adults with diabetes who had experienced a severe low blood sugar episode died within three years of the incident, according to a Johns Hopkins Bloomberg School of Public Health study.

"Our results show that GAM has potential as a biomarker for susceptibility to hypoglycemic episodes. However, more studies will have to be conducted in order to demonstrate if this biomarker can be of practical clinical use," concluded the authors.

For more information follow the link: https://doi.org/10.1007/s00592-018-1180-5