Adaptations in brain lactate handling in response to hypoglycemia may play a role in the pathophysiology of impaired awareness of hypoglycemia (IAH). Therefore, we determined the effect of high-intensity interval training (HIIT)-induced hyperlactatemia on brain lactate during subsequent hypoglycemia in type 1 diabetic (T1DM) patients with IAH, in T1DM patients with normal awareness of hypoglycemia (NAH) and in healthy controls. Brain lactate concentration was determined using a J-difference editing semi-LASER 1H-MRS sequence. After HIIT, brain lactate concentration increased most in T1DM IAH, consistent with an enhanced lactate transport capacity, and also dropped most during subsequent hypoglycemia, suggestive for increased lactate oxidation.
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