[HTML][HTML] Lactate preserves neuronal metabolism and function following antecedent recurrent hypoglycemia

RI Herzog, L Jiang, P Herman, C Zhao… - The Journal of …, 2013 - Am Soc Clin Investig
RI Herzog, L Jiang, P Herman, C Zhao, BG Sanganahalli, GF Mason, F Hyder, DL Rothman
The Journal of clinical investigation, 2013Am Soc Clin Investig
Hypoglycemia occurs frequently during intensive insulin therapy in patients with both type 1
and type 2 diabetes and remains the single most important obstacle in achieving tight
glycemic control. Using a rodent model of hypoglycemia, we demonstrated that exposure to
antecedent recurrent hypoglycemia leads to adaptations of brain metabolism so that modest
increments in circulating lactate allow the brain to function normally under acute
hypoglycemic conditions. We characterized 3 major factors underlying this effect. First, we …
Hypoglycemia occurs frequently during intensive insulin therapy in patients with both type 1 and type 2 diabetes and remains the single most important obstacle in achieving tight glycemic control. Using a rodent model of hypoglycemia, we demonstrated that exposure to antecedent recurrent hypoglycemia leads to adaptations of brain metabolism so that modest increments in circulating lactate allow the brain to function normally under acute hypoglycemic conditions. We characterized 3 major factors underlying this effect. First, we measured enhanced transport of lactate both into as well as out of the brain that resulted in only a small increase of its contribution to total brain oxidative capacity, suggesting that it was not the major fuel. Second, we observed a doubling of the glucose contribution to brain metabolism under hypoglycemic conditions that restored metabolic activity to levels otherwise only observed at euglycemia. Third, we determined that elevated lactate is critical for maintaining glucose metabolism under hypoglycemia, which preserves neuronal function. These unexpected findings suggest that while lactate uptake was enhanced, it is insufficient to support metabolism as an alternate substrate to replace glucose. Lactate is, however, able to modulate metabolic and neuronal activity, serving as a “metabolic regulator” instead.
The Journal of Clinical Investigation