While other organs in the body may rely on alternative sources of energy, such as fatty acids, the brain relies almost solely on glucose, using ketones as a last resort.
For this reason, the blood brain barrier is rich in Glut1 active glucose transporters, and over 99% of the glucose that passes it is used by neurons and glia.
Thus, the metabolic efficiency and continuous demands of the brain render it uniquely susceptible to fluctuations in glucose concentration in the body.
Diabetes and memory loss are closely linked, and poorly controlled diabetes can cause memory loss. The brain runs on glucose and brain glucose storage is limited.
To maintain normal brain functioning, people with diabetes need a constant supply of glucose from their blood.
Memory loss and reduced brain functioning can occur during periods of low blood glucose (hypoglycemia)and high blood glucose (hyperglycemia) can affect memory over the longer term for people with type 1 and type 2 diabetes.
Uncontrolled diabetes may increase the risks of suffering memory loss. Higher than normal blood glucose levels are known to damage the nerves and the brain is not immune to these effects. The longer that the glucose remains in the blood, the less fuel the brain has to function and retain memories.
Type 2 diabetes carries a risk of Alzheimer’s disease that is twice higher than for non-diabetic individuals.
The risk is higher when diabetes is less well controlled, so keeping good diabetes management may help to prevent Alzheimer’s from developing.
High blood glucose effects your brain
Diabetes can damage the tiny blood vessels in your eyes, causing loss of vision, even blindness. The disease can also damage the nerves in your feet, making walking painful with a high degree of risk that you may need an amputation of the foot or leg.
These consequences of diabetes are well known.
But what is not so well known is that diabetes can also damage the tiny blood vessels in your brain. This damage affects your brains white matter.
White matter is that part of the brain where the nerves communicate with each other.
If your nerves cannot communicate with each other or are otherwise damaged you will experience vascular cognitive impairment or vascular dementia.
Vascular cognitive impairment is a decline in thinking abilities caused by disease that damages the brain’s blood vessels.
Vascular dementia is a common form of dementia caused by a reduced supply of blood to the brain, which can have various causes.
Both types of dementia can be caused by both types of diabetes.
Statistics, however, suggest that people with type 1 diabetes are less likely to experience dementia if their glucose levels are well controlled.
The problem for type 2 diabetes is that the disease is usually just one of a cluster of disorders ― high blood glucose levels, excessively high blood pressure, abnormal cholesterol levels or excess body fat around the waist ― known as metabolic syndrome.
In fact, if you have type 2 diabetes there is an 85% chance that you also have metabolic syndrome. And just like diabetes, excessive blood pressure and abnormal cholesterol levels also damage your blood vessels.
This combination of risks of damage to your blood vessels means that keeping your blood glucose levels under control is vital for diabetics.
While vascular disease can cause cognitive impairment, it can also contribute to impairments in thinking and behaviour in a person with other brain diseases such as Alzheimer’s disease.
Low blood glucose and the brain
All of us diabetics have probably experienced blood glucose levels that have dropped too low.
The symptoms are easy to recognise:
difficulty in thinking
trouble walking or talking
Severely low blood sugar can affect your mood, give you seizures or convulsions, make you pass out or put you in a coma.
If you only occasionally go too low there is unlikely to be an adverse long-term effect on your brain. However, if you have frequent bouts of low blood glucose, you can become unaware of it, a condition known as hypoglycaemia unawareness.
With hypoglycaemia unawareness, you do not experience the usual early symptoms of low glucose levels ― nausea, hunger, shakiness, cold or clammy skin, and/or a pounding heart ― which, if you were asleep, would be enough to wake you up.
In other words, with hypoglycaemia unawareness, your blood glucose can continue to drop until it goes so low that you lapse into a coma.
This unawareness of what is happening to you glucose level can catch you when you least suspect it; eg, when you are driving or walking, causing an accident or a fall.
A major question concerning hypoglycaemia unawareness is whether repeated bouts of low glucose can cause long-term memory problems or raise the risk of dementia. The answer is far from clear.
One large study, the Diabetes Control & Complications Trial, indicated that low blood glucose in persons with type 1 diabetes does not have a long-term impact on memory or the ability to think.
But another study suggests that, in older people with type 2 diabetes, there is a link between severe low blood glucose levels and a higher risk of dementia.
As you can see, diabetes definitely can damage your brain but how it does so is not at all clear.
But what is clear is that diabetics need to control their blood glucose levels fastidiously, ensuring that they seldom go too high or too low.
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