Could elevated blood sugars make study time tougher?
We are fully in the throes of another school year. This year had already brought its share of unique challenges, but for students with T1D, it could be requiring even more work!
A 2020 study published in Diabetes Care (August 2020 vol 43) studied brain scan activity in young people aged 11-19 while performing special memory tests. This study compared brain activity, an indication of how “hard” we have to work to commit things to memory and then recall those memories later. IN this particular test young people were asked to memorize a series of objects or numbers and then later recall whether the numbers and items they were being shown had been part of the earlier grouping. (the Sternbern item recognition test) the results were compared between young people with diabetes with “in range” blood sugars and those same young people with substantially elevated blood glucose. Scans of young people without diabetes were compared for controls. All data was adjusted for age, and history of severe hypoglycemia or DKA were exclusions for this study. The objective was to gather data on the impact on hypoglycemia as opposed to other potentially complicating factors of type 1 diabetes.
- Young people with type 1 in “in range” blood sugar range 90-180mg/dl , 5-10MMOL
- Young people with type 1 in “hyperglycemic range” blood sugar range (270-450mg/dl , 15-25MMOL)
- Young people without diabetes
Conclusions showed that young people with T1D showed significantly higher brain activity than their peers without diabetes. This means that in general young people with T1D have more brain activity to accomplish the same tasks as their peers. However when tested at elevated blood sugar levels actually saw a drop in activity during hyperglycemia. In a hyperglycemic state it appears that young people are not able to activate this compensatory state of increased brain activity to facilitate memory and recall. This drop in activity correlated to lower performance scores in hyperglycemia than “in range”. In short, this means that when our blood sugars are high we just don’t have the same capacity to remember and recall spatial information. (additional information on this study can be found here: https://care.diabetesjournals.org/content/early/2020/05/27/dc20-0171)
This can be as simple as not being able to find where we left our phone, or our backpack, or as complex as not being able to recall multiplication tables, mnemonic devices, or other event or location-based learning that engaged special memory. Elevated blood sugars may be making young people with diabetes work harder than their peers to make the grade, and persistent substantially elevated blood sugars can seriously impair academic and even goal-directed behavior like doing chores, and athletic performance as spatial memory impacts these areas as well.
This points directly to two important points for students living with diabetes. First is the importance of accommodations. Students should be able to check blood sugars before exams or important tryouts. They should either be given time and resources to get blood sugars back into range, extended time to complete these exams or tryouts, or be able to reschedule them for a time when blood sugars are in an appropriate range.
This information also points to the importance of maintaining blood sugars in a healthy target range. While we don’t want to introduce hypoglycemia, we also should not blindly prescribe to the “better high than low” mentality. Elevations in blood sugar may significantly impact the quality of life, and long-term success of our young people with type 1 diabetes.
Here at IDS we work alongside families, young people, and young adults to optimize their blood sugar management to reduce the burdens of both hypo, and hyperglycemia to help out clients have their best experience not only clinically, but academically, socially and extracurricularly.
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