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Abstract #0306

Increased Brain Monocarboxylic Acid Transport & Metabolism in T1DM Patients with Hypoglycemia Unawareness

Henk M. De Feyter1, Barbara I. Gulanski2, Kathleen A. Page3, Anne Howard O'Connor, Ellen V. Hintz, Susan M. Harman, Renata Belfort De Aguiar, Graeme F. Mason, Douglas L. Rothman, Robert S. Sherwin

1Diagnostic Radiology, Yale University, New Haven, CT, USA; 2VA Connecticut Healthcare System, West Haven; 3USC Keck School of Medicine, Los Angeles, USA

Previously we showed in well-controlled type 1 diabetes patients increased brain metabolism of acetate, a monocarboxylic acid (MCA) transported over the blood-brain barrier via MCT1. However, it is unclear whether these adaptations are related to frequency and severity of hypoglycemic episodes or type 1 diabetes per se. We therefore investigated the relationship between cortical metabolic adaptations and i) severity of antecedent hypoglycemia unawareness and ii) counterregulatory response to acute hypoglycemia using 13C MRS and infusion of [2-13C]-acetate and show how the severity of hypoglycemia unawareness and lack of counterregulatory response is independent of diabetes and correlates with the degree of MCA transport and metabolism.