Type 1 Diabetes: What’s Happening Inside the Brain?

Adapting to the increased physiological needs of your body is imperative when managing type 1 diabetes (T1D) — but the condition can also cause changes in your brain that influence how you think and feel.

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What are the emotional effects of T1D?

If you feel like you are on a rollercoaster of emotions, you are not alone. Many people with T1D struggle to maintain stable moods due to blood sugar fluctuations — also known as glycemic variability. Low blood sugar (hypoglycemia) can cause confusion, nervousness and irritability, while high blood sugar (hyperglycemia) can cause tension, anger and sadness. Extreme and regular fluctuations in blood sugar and mood can lead to more severe moods, such as clinical depression, which in turn can result in diabetes burnout — a state of giving in to the diabetes and no longer trying to manage it because you are burnt out from the highs and lows that are going on inside your brain.

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So, why do fluctuating levels of glucose have such a drastic impact on mood? The reasons are varied and include:

· Damage to the amygdala — the part of the brain that controls the stress hormone cortisol and your response to stress

· Damage to the thalamus — the part of the brain that helps with self-control

Some mood changes can also be explained by the lethargy that results from your brain not having access to the energy that comes from sufficient glucose. With low energy levels, you simply don’t have the brain power to manage your moods.

The specific physiological impact of glucose can be further explained according to glucose levels:

Hyperglycemia

High blood glucose can lead to an increase in a chemical known as glutamate, which is linked to depression. In particular, hyperglycemia increases glutamate levels in the region of the brain involved in regulating emotions. Interestingly, research indicates this isn’t the case for people without T1D.

Hypoglycemia

Low blood glucose can also affect the levels of important chemicals within the brain, such as acetylcholine and glutamate. Acetylcholine is a neurotransmitter responsible for transmitting signals between nerve cells within the brain. These signals control vital psychological and physical functions, such as heart rate, breathing and muscular movements.

The brains of some people with T1D have been shown to adapt over time to no longer respond to low blood sugar levels. While this might sound beneficial, awareness of hypoglycemia is an important protective mechanism that alerts you to take the appropriate self-management steps. Therefore, researchers are currently looking at ways to maintain or restore awareness of hypoglycemia in people with T1D.

What are the cognitive effects of T1D?

Research suggests that T1D is associated with some degree of cognitive impairment. Specifically, some people with T1D have reduced mental speed and are less able to apply previous knowledge to new situations. However, these cognitive effects are mild to moderate and there are no reported effects on learning or memory. Poorly controlled T1D may also increase an individual’s risk of developing dementia later in life.

So, what exactly is happening in the brain to cause these cognitive changes? Cognitive dysfunction in people with T1D is most likely the result of chronic hyperglycemia and the subsequent damage to small blood vessels throughout the brain. T1D has been associated with brain abnormalities detected by magnetic resonance imaging (MRI) scans, with these abnormalities present as subtle, localized reductions in brain volume and changes in brain connectivity. These changes may, in part, be due to the negative effects of T1D on childhood brain development. In people with poor control of blood glucose levels, cognitive function may decline more rapidly.

Healthy glucose levels, healthy mind

Clearly, maintaining your blood glucose levels within a healthy range can play a critical role in stabilizing your mood and reducing the risk of cognitive decline. Research is ongoing to try and better understand the long- and short-term effects of T1D on the brain, but in the meantime, glucose management is one of the best ways to take care of your mind.

Want to learn more about type 1 diabetes? Read “Type 1 Diabetes Questions and Answers,” “Six Type 1 Diabetes Symptoms You Need to Know” and see our type 1 diabetes videos.

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