Diabetic encephalopathy is damage to the brain caused by diabetes. A relatively unknown complication, encephalopathy is becoming more widely recognized as more people are diagnosed with type 1 and type 2 diabetes. Diabetic encephalopathy presents itself both mentally and physically. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses, or severe impairment like dementia. The complication can also cause tremors, lack of coordination, and even seizures.

Diabetic encephalopathy is largely due to acute hypoglycemia (blood sugar levels are too low) or severe hyperglycemia (blood sugar levels are too high). The condition manifests itself differently between the two major types of diabetes.

Type 2 diabetes

Encephalopathy in those with type 2 diabetes increases the risk of developing Alzheimer’s disease or other forms of dementia. According to a 2011 study, those with type 2 diabetes were twice as likely to develop Alzheimer’s and 1.75 times more likely to develop other forms of dementia than healthy participants.

This increased risk could be due to many different factors brought about from type 2 diabetes.

It could be caused by the body’s resistance to insulin, which makes it difficult for the brain to break down amyloid, a protein that forms brain plaques. Brain plaques are abnormal clusters of this protein that block cell-to-cell signaling at the synapses—a symptom infamous for contributing to the development of Alzheimer’s disease.

Type 2 diabetic encephalopathy can also be generated from hyperglycemia or the conditions that commonly accompany type 2 diabetes like high blood pressure, obesity, or high cholesterol.

Oxidative stress is another provoker of the complication. This stems from an imbalance between reactive oxygen molecules and the body’s ability to detoxify those molecules, or according to the Alzheimer’s Association, “when the production of free radicals exceeds the antioxidant capacity of a cell.” Oxidative stress is a major component of the development of Alzheimer’s.

Finally, encephalopathy could be caused by microvascular inflammation affecting the blood vessels in the brain. This makes the brain’s vessels harden and decrease in blood flow. This diminished amount of blood paired with an excess of insulin in the brain can cause the brain to not process proteins properly.

Type 1 diabetes

Since type 1 diabetes typically occurs in younger people, encephalopathy is less likely to develop into dementia. However, type 1 diabetics with encephalopathy are more likely to develop learning disabilities and lack of memory retrieval. As the brain is growing quickly, the disease might stunt intelligence development, precipitating impaired school and professional performance.

Type 1 diabetic encephalopathy may be due to insulin deficiency, which affects neurotransmitters and other parts of the brain. Individuals can also get it after hyperglycemic emergencies such as diabetic ketoacidosis, a serious condition created from a buildup of blood acids in the body. Although rare, it can stunt speech and higher mental functions and spike unprecedented irritability after the emergency. However, this encephalopathy can be reversed in the months after a type 1 diabetic recovers from the emergency.

Treatment

For treatment, maintaining healthy blood sugar levels is crucial, because that will help slow or stop any further damage. Medical professionals are still discovering appropriate ways to treat the complication, but each individual will be treated in a specific way depending on the cause and the evident symptoms. For type 2 diabetics displaying encephalopathy, prescription drugs for Alzheimer’s and dementia are available.

If you are experiencing confusion, loss of memory, tremors, personality changes, or other indicators of cognitive decline, see your doctor immediately.