Skip to main content
SpringerLink
Log in

Prevention of Severe Hypoglycemia by Continuous EEG Monitoring

  • Chapter
  • First Online:
Prediction Methods for Blood Glucose Concentration

Part of the book series: Lecture Notes in Bioengineering ((LNBE))

  • 1339 Accesses

Abstract

Background: The brain is dependent on constant glucose supply and hypoglycaemia results in reduced cognition, unconsciousness, seizures, and possible death. Prevention of hypoglycaemia is accordingly a key point in diabetes treatment. The effect of hypoglycemia on the electrical activity of the brain is well described. We propose an alarm device for severe hypoglycaemia based on continuous electroencephalography (EEG), real-time data analysis by an automated algorithm and an auditory alarm. Methods and results: People with type 1 diabetes (T1D) were exposed to hypoglycaemia by excess insulin administration. EEG was scored visually by neurophysiologists for deviations compatible with neuroglycopenia. From these initial experiments, a multiparameter algorithm was developed by applying an artificial neural network. Subsequently series of experiments were conducted in T1D patients in order to improve the algorithm and to test its clinical applicability. Thus people with T1D with normal, reduced, or absent awareness of hypoglycaemia were exposed to hypoglycaemia both during daytime and during sleep. EEG was analyzed by the automated algorithm. All patients developed hypoglycaemia-associated EEG changes. During the sleep experiments, these changes occurred irrespective of sleep stage, and the majority of patients woke up when they received an auditory alarm at the onset of hypoglycaemia-associated EEG changes. We found that the EEG changes were independent of diabetes duration, awareness status, and counter-regulatory hormone response. In subsequent studies, a miniaturized partly implanted EEG recorder was tested. The device consists of a small implant recording the EEG and an external device which wirelessly receives EEG and gives an alarm when hypoglycaemia-associated EEG changes are apparent. In preliminary studies of one month duration, we found that the device was well tolerated and successfully warned the patients in time to take appropriate action before severe hypoglycaemia was present. Conclusion: The results obtained so far hold promises for the development of an EEG-based alarm for severe hypoglycaemia in people with T1D. Hypoglycaemia-associated EEG changes seem to be a general feature which makes a common algorithm applicable. Further studies are needed to define the sensitivity and tolerability of the partly implanted EEG-based device for severe hypoglycaemia during long-term use.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Banck-Petersen, P., Larsen, T., Pedersen-Bjergaard, U., Bie-Olsen, L., Hoi-Hansen, T., Thorsteinsson, B.: Concerns about hypoglycaemia and late complications in patients with insulin-treated diabetes. Eur. Diabetes Nurs. 4(3), 113–118 (2007). doi:10.1002/edn.91

    Google Scholar 

  2. Berger, H.: Über das Elektrenkephalogramm des Menschen. Archiv für Psychiatrie und Nervenkrankheiten 87(1), 527–570 (1929). doi:10.1007/BF01797193

    Google Scholar 

  3. Boudin, G., Remond, A., Castaigne, P.: Electroencephalographic study of spontaneous hypoglycemia due to adenoma of the islands of Langerhans; considerations on the electroencephalographic modifications of hypoglycemia. Rev. Neurol. (Paris) 84(2), 171–174 (1951)

    Google Scholar 

  4. Cryer, P.E.: Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N. Engl. J. Med. 369(4), 362–372 (2013)

    Article  Google Scholar 

  5. Elsborg, R., Remvig, L., Beck-Nielsen, H., Juhl, C.: Detecting hypoglycemia by using the brain as a biosensor, vol. 2. Biosensors for Health, Environment and Biosecurity (2011)

    Google Scholar 

  6. Iber, C., Ancoli-Israel, S., Chesson Jr, A.L., Quan, S.: The AASM Manual for the Scoring of Sleep and Associated Events. American Academy of Sleep Medicine, Westchester (2007)

    Google Scholar 

  7. Joachims, T.: Making large-scale SVM learning practical. In: Schlkopf, B., Burges, C., Smola, A. (eds.) Advances in Kernel Methods - Support Vector Learning. MIT Press, Cambridge (1999)

    Google Scholar 

  8. Juhl, C.B., Hojlund, K., Elsborg, R., Poulsen, M.K., Selmar, P.E., Holst, J.J., Christiansen, C., Beck-Nielsen, H.: Automated detection of hypoglycemia-induced EEG changes recorded by subcutaneous electrodes in subjects with type 1 diabetes-the brain as a biosensor. Diabetes Res. Clin. Pract. 88(1), 22–28 (2010)

    Article  Google Scholar 

  9. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group: prolonged nocturnal hypoglycemia is common during 12 months of continuous glucose monitoring in children and adults with type 1 diabetes. 33(5), 1004–1008 (2010)

    Google Scholar 

  10. Ly, T.T., Nicholas, J.A., Retterath, A., Lim, E.M., Davis, E.A., Jones, T.W.: Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA 310(12), 1240–1247 (2013)

    Article  Google Scholar 

  11. Maahs, D.M., Calhoun, P., Buckingham, B.A., Chase, H.P., Hramiak, I., Lum, J., Cameron, F., Bequette, B.W., Aye, T., Paul, T., Slover, R., Wadwa, R.P., Wilson, D.M., Kollman, C., Beck, R.W.: A randomized trial of a home system to reduce nocturnal hypoglycemia in type 1 diabetes. Diabetes Care 37(7), 1885–1891 (2014)

    Article  Google Scholar 

  12. Nguyen, H.T., Ghevondian, N., Jones, T.W.: Real-time detection of nocturnal hypoglycemic episodes using a novel non-invasive hypoglycemia monitor. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2009, 3822–3825 (2009)

    Google Scholar 

  13. Oz, G., Tesfaye, N., Kumar, A., Deelchand, D.K., Eberly, L.E., Seaquist, E.R.: Brain glycogen content and metabolism in subjects with type 1 diabetes and hypoglycemia unawareness. J. Cereb. Blood Flow Metab. 32(2), 256–263 (2012)

    Article  Google Scholar 

  14. Pedersen-Bjergaard, U., Kristensen, P.L., Beck-Nielsen, H., Norgaard, K., Perrild, H., Christiansen, J.S., Jensen, T., Hougaard, P., Parving, H.H., Thorsteinsson, B., Tarnow, L.: Effect of insulin analogues on risk of severe hypoglycaemia in patients with type 1 diabetes prone to recurrent severe hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-endpoint crossover trial. Lancet Diabetes Endocrinol 2(7), 553–561 (2014)

    Article  Google Scholar 

  15. Plank, J., Kohler, G., Rakovac, I., Semlitsch, B.M., Horvath, K., Bock, G., Kraly, B., Pieber, T.R.: Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with type 1 diabetes: a 12-year follow-up. Diabetologia 47(8), 1370–1375 (2004)

    Article  Google Scholar 

  16. Pramming, S., Thorsteinsson, B., Stigsby, B., Binder, C.: Glycaemic threshold for changes in electroencephalograms during hypoglycaemia in patients with insulin dependent diabetes. Br. Med. J. (Clin Res Ed) 296(6623), 665–667 (1988)

    Article  Google Scholar 

  17. Ramchandani, N., Arya, S., Ten, S., Bhandari, S.: Real-life utilization of real-time continuous glucose monitoring: the complete picture. J. Diabetes Sci. Technol. 5(4), 860–870 (2011)

    Article  Google Scholar 

  18. Remvig, L.S., Elsborg, R., Sejling, A.S., Sorensen, J.A., Sonder Snogdal, L., Folkestad, L., Juhl, C.B.: Hypoglycemia-related electroencephalogram changes are independent of gender, age, duration of diabetes, and awareness status in type 1 diabetes. J. Diabetes. Sci. Technol. 6(6), 1337–1344 (2012)

    Article  Google Scholar 

  19. Ross, I.S., Loeser, L.H.: Electroencephalographic findings in essential hypoglycemia. Electroencephalogr. Clin. Neurophysiol. 3(2), 141–148 (1951). doi:10.1016/0013-4694(51)90003-X

    Google Scholar 

  20. Sejling, A.S., Kjaer, T.W., Pedersen-Bjergaard, U.: S., R.L., Duun-Henriksen, J., Tarnow, L., Faber, J., Holst, J.J., Hilsted, L., Thorsteinsson, B., Juhl, C.B.: Cerebral electrical activity during recurrent hypoglycemia in patients with type 1 diabetes and normal hypoglycemia awareness or hypoglycemia unawareness (abstract). Diabetes 63, A66 (2014)

    Google Scholar 

  21. Sejling, A.S., Kjær, T.W., Pedersen-Bjergaard, U., Diemar, S.S., Frandsen, C.S., Hilsted, L., Faber, J., Holst, J.J., Tarnow, L., Nielsen, M.N., Remvig, L.S., Thorsteinsson, B., Juhl, C.B.: Hypoglycemia-associated changes in the electroencephalogram in patients with type 1 diabetes and normal hypoglycemia awareness or unawareness. Diabetes 64(5), 1760–1769 (2015)

    Article  Google Scholar 

  22. Sigurdsson, S., Larsen, J., Hansen, L., Philipsen, P., Wulf, H.: Outlier estimation and detection application to skin lesion classification. In: IEEE International Conference on Acoustics, Speech, and Signal Processing (ICASSP), vol. 1, pp. I–1049–I–1052 (2002). doi:10.1109/ICASSP.2002.5743975

  23. Snogdal, L.S., Folkestad, L., Elsborg, R., Remvig, L.S., Beck-Nielsen, H., Thorsteinsson, B., Jennum, P., Gjerstad, M., Juhl, C.B.: Detection of hypoglycemia associated EEG changes during sleep in type 1 diabetes mellitus. Diabetes Res. Clin. Pract. 98(1), 91–97 (2012)

    Article  Google Scholar 

  24. Tamborlane, W.V., Beck, R.W., Bode, B.W., Buckingham, B., Chase, H.P., Clemons, R., Fiallo-Scharer, R., Fox, L.A., Gilliam, L.K., Hirsch, I.B., Huang, E.S., Kollman, C., Kowalski, A.J., Laffel, L., Lawrence, J.M., Lee, J., Mauras, N., O’Grady, M., Ruedy, K.J., Tansey, M., Tsalikian, E., Weinzimer, S., Wilson, D.M., Wolpert, H., Wysocki, T., Xing, D., Chase, H.P., Fiallo-Scharer, R., Messer, L., Gage, V., Burdick, P., Laffel, L., Milaszewski, K., Pratt, K., Bismuth, E., Keady, J., Lawlor, M., Buckingham, B., Wilson, D.M., Block, J., Benassi, K., Tsalikian, E., Tansey, M., Kucera, D., Coffey, J., Cabbage, J., Wolpert, H., Shetty, G., Atakov-Castillo, A., Giusti, J., O’Donnell, S., Ghiloni, S., Hirsch, I.B., Gilliam, L.K., Fitzpatrick, K., Khakpour, D., Wysocki, T., Fox, L.A., Mauras, N., Englert, K., Permuy, J., Bode, B.W., O’Neil, K., Tolbert, L., Lawrence, J.M., Clemons, R., Maeva, M., Sattler, B., Weinzimer, S., Tamborlane, W.V., Ives, B., Bosson-Heenan, J., Beck, R.W., Ruedy, K.J., Kollman, C., Xing, D., Jackson, J., Steffes, M., Bucksa, J.M., Nowicki, M.L., Van Hale, C., Makky, V., O’Grady, M., Huang, E., Basu, A., Meltzer, D.O., Zhao, L., Lee, J., Kowalski, A.J., Laffel, L., Tamborlane, W.V., Beck, R.W., Kowalski, A.J., Ruedy, K.J., Weinstock, R.S., Anderson, B.J., Kruger, D., LaVange, L., Rodriguez, H.: Continuous glucose monitoring and intensive treatment of type 1 diabetes. N. Engl. J. Med. 359(14), 1464–1476 (2008)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hyposafe A/S, 2800, Lyngby, Denmark

    Claus Bogh Juhl, Jonas Duun-Henriksen & Rasmus Elsborg Madsen

  2. Department of Endocrinology, Sydvestjysk Hospital, 6700, Esbjerg, Denmark

    Claus Bogh Juhl

  3. Department of Plastic Surgery, Odense University Hospital, 5000, Odense C, Denmark

    Jens Ahm Sørensen

  4. Faculty of Health Science, University of Southern Denmark, 5000, Odense, Denmark

    Claus Bogh Juhl & Anne Sophie Sejling

  5. Department of Cardiology, Nephrology and Endocrinology, NordsjæLands Hospital, 3400, Hillerød, Denmark

    Anne Sophie Sejling

Authors
  1. Claus Bogh Juhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonas Duun-Henriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens Ahm Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Sophie Sejling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rasmus Elsborg Madsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claus Bogh Juhl .

Editor information

Editors and Affiliations

  1. Institute for Design and Control of Mechatronical Systems, Johannes Kepler University Linz, Linz, Austria

    Harald Kirchsteiger

  2. Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark

    John Bagterp Jørgensen

  3. Institut de Génomique Fonctionnelle de Montpellier, Montpellier cedex 5, France

    Eric Renard

  4. Institute for Design and Control of Mechatronical Systems, Johannes Kepler University Linz, Linz, Austria

    Luigi del Re

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Juhl, C.B., Duun-Henriksen, J., Sørensen, J.A., Sejling, A.S., Elsborg Madsen, R. (2016). Prevention of Severe Hypoglycemia by Continuous EEG Monitoring. In: Kirchsteiger, H., Jørgensen, J., Renard, E., del Re, L. (eds) Prediction Methods for Blood Glucose Concentration. Lecture Notes in Bioengineering. Springer, Cham. https://doi.org/10.1007/978-3-319-25913-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-25913-0_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25911-6

  • Online ISBN: 978-3-319-25913-0

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics

Search

Navigation