Hypoglycemia — episodes of dangerously low blood sugar — is the most feared acute complication of diabetes and can lead to shaking, convulsions, coma, or even death in extreme cases. Young diabetic children who may not be able to recognize or communicate the signs of impending hypoglycemia are especially vulnerable. Technologies coming onto the market in the near term have the ability to warn patients of hypoglycemia, and it is critical that the technology is suitable for use in children. The NIH has established the Diabetes Research in Children Network (DirecNet) to provide independent assessments of glucose monitoring technology and its impact on the management of type 1 diabetes in children, and this important work would be delayed without additional funds.

HOPE AND PROGRESS THROUGH RESEARCH
Federal funding has stimulated renewed interest and investment in hypoglycemia research — an undertaking that requires close collaboration between diabetes investigators who understand glucose metabolism and neuroscientists who study how the brain works.

When a patient with type 1 diabetes experiences recurring episodes of hypoglycemia, that person can lose the ability to sense when the next episode is about to occur — a condition known as "hypoglycemia unawareness." Islet transplantation has been shown to reverse hypoglycemia unawareness and to drastically reduce the frequency of hypoglycemia even in patients who have to resume insulin shots after transplantation.

State-of-the-art imaging technologies are helping researchers to gain a better understanding of what is happening in the brain during hypoglycemia. Some regions of the brain display reduced activity in response to hypoglycemia; other areas respond differently in patients who have hypoglycemia unawareness compared to those who can detect the onset of hypoglycemia. Identifying parts of the brain that are involved in the response to hypoglycemia will help investigators design new therapies to combat it.

Research in animal models is beginning to reveal how the brain defends itself from injury when glucose levels drop dangerously low. By identifying "alternate fuels" that the brain turns to under conditions of hypoglycemia, investigators can design new treatments to prevent hypoglycemia-induced brain damage.

Blood Glucose Awareness Training (BGAT) is a behavioral strategy that teaches type 1 diabetes patients how to better recognize and manage high and low glucose levels. Among other benefits, BGAT is known to decrease the number of hypoglycemic episodes, reduce fear of hypoglycemia, and improve quality of life in patients who have been trained through this program.

New behavioral strategies are being tested to protect patients from hypoglycemia during sleep, such as eating a specific type of bedtime snack or changing the time of exercise.

ARTIFICIAL PANCREAS (also see http://www.jdrf.org/artificialpancreas)
Type 1 diabetes patients must treat themselves several times each day, measuring their blood glucose level and injecting an appropriate amount of insulin, either through shots or an insulin pump, to maintain blood glucose as close to normal as possible. For small children with type 1 diabetes, a team of trained caregivers — parents, grandparents, babysitters, teachers, coaches — must be available at all times, day and night, to manage the child's diabetes. The development of a "closed-loop" artificial pancreas would greatly alleviate the daily burden of disease management for all type 1 diabetes patients and their caregivers. A fully automated artificial pancreas would continuously monitor a person's blood sugar, infuse insulin as necessary when blood sugar gets too high, and warn the patient of dangerously low blood sugar.

HOPE AND PROGRESS THROUGH RESEARCH
New technologies coming onto the market are revolutionizing diabetes management. These devices help type 1 diabetes patients improve glucose control, reduce life-threatening episodes of hypoglycemia, and lower the risk of long-term complications.

The development of insulin pumps has provided a less painful alternative to multiple injections each day. Pumps continuously infuse a low level of insulin, but still require the user to manually calculate and trigger an appropriate insulin dose in response to rising glucose levels after meals.

Traditional finger-stick glucose tests provide patients with only a single glucose value at a specific point in time. In contrast, new continuous glucose monitoring technology, which provide continuous, real-time feedback on glucose levels, helps patients better understand trends in their glucose level: whether it is falling (signaling the need to eat to avoid hypoglycemia) or rising (indicating the need for an insulin dose).

Investigators have found that type 1 diabetes patients who use continuous monitoring systems spend more time in the normal glucose range than those who rely on finger stick glucose measurements several times each day. This observation is critical because short term variation or swings in glucose levels may be as important as overall, long-term glucose control in predicting the risk of complications.

Go to Future Opportunities...