In a study from Johns Hopkins Medicine, scientists found why people with diabetes who experience periods of low blood sugar—a common occurrence in those new to blood sugar management—are more likely to have worsening diabetic eye disease.
They have linked such low blood sugar levels with a molecular pathway that is turned on in oxygen-starved cells in the eye.
Eye disease among people with diabetes is among the most preventable causes of blindness in the U.S. Diabetic retinopathy, which occurs in up to a third of people with diabetes, is characterized by the overgrowth of abnormal blood vessels in the retina.
Temporary low blood sugar happens once or twice a day in people with insulin-dependent diabetes and often among people newly diagnosed with the condition.
Low glucose levels can also occur during sleep in people with non-insulin-dependent diabetes.
The current results showed that these periodic low glucose levels cause an increase in certain retinal cell proteins, resulting in an overgrowth of blood vessels and worsening diabetic eye disease.
In the study, the team analyzed protein levels in human and mouse retinal cells and intact retinas grown in an environment of low glucose in the laboratory, as well as in mice that had occasional low blood sugar.
They found that low blood sugar levels in human and mouse retinal cells caused molecular changes that can lead to blood vessel overgrowth.
This could cause the growth of abnormal, leaky blood vessels—the key culprit of vision loss in people with diabetic eye disease.
The team says the current study suggests that people with diabetic retinopathy may be particularly vulnerable to periods of low glucose, and keeping glucose levels stable should be an important part of glucose control.
The researchers plan to study whether low blood sugar in people with diabetes may impact similar molecular pathways in other organs, such as the kidney and brain.
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The study was conducted by Akrit Sodhi et al and published in Cell Reports.
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