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. Now, researchers at Johns Hopkins Medicine say they have linked such low blood sugar levels with a molecular pathway that is turned on in oxygen-starved cells in the eye.
The research, involving human and mouse eye cells and intact retinas grown in a low sugar (low glucose) environment in the laboratory, as well as mice with low glucose levels, was published in the January issue of Cell Reports.
The authors say 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.
For the study, the researchers 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 glucose levels in human and mouse retinal cells caused a cascade of molecular changes that can lead to blood vessel overgrowth.
The researchers found that, in response to low glucose, the cells increased levels of a transcription factor, called hypoxia-inducible factor (HIF)-1α. This turned on the cellular machinery — including GLUT1 — needed to improve their ability to utilize available glucose, preserving the limited oxygen available for energy production by retinal neurons.
However, in low-oxygen environments, as occurs in the retinas of patients with diabetic eye disease, this normal, physiologic response to low glucose triggered a flood of HIF-1α protein into the cells’ nucleus, the cell’s control center.
This resulted in an increase in the production of proteins such as VEGF and ANGPTL4, which cause the growth of abnormal, leaky blood vessels — the key culprit of vision loss in people with diabetic eye disease.