Processing of food stimuli is selectively enhanced during insulin-induced hypoglycemia in healthy men

Recently it has been reported that during insulin-induced hypoglycemia selective attention is directed to food stimuli suggesting an adaptive cognitive strategy to escape from this potentially dangerous metabolic state. Here, we tested this hypothesis using a short-term memory task. We also aimed to define a hypoglycemic threshold level at which such an adaptive cognitive strategy first occurs. Fifteen healthy men underwent stepwise hypoglycemic (plasma glucose: 4.1-3.6-3.1-2.6 mmol/l) and euglycemic clamp experiments. Clamps were performed in a single blind fashion within a cross-over design with the order balanced across subjects. During the clamps cognitive function tests (short-term recall of food-related and non-food-related words; Stroop task) were applied at baseline and each hypoglycemic plateau, and at the corresponding time intervals of the euglycemic clamp. Performance on all cognitive function tests applied deteriorated during the hypoglycemic as compared to the euglcemic clamp (all P<0.02). Separate analyses at each hypoglycemic plateau revealed that food and non-food related short-term memory was similar during baseline and mild hypoglycemia. However, at the hypoglycemic target level of 2.6 mmol/l recall of food related words was higher than non-food related words when compared to the euglycemic control clamp condition (p=0.024). Performance on the word-color conflict Stroop task became significantly impaired first at the lowest hypoglycemic plateau (2.6 mmol/l), while performance on the Stroop subtests 'color naming' and 'word reading' were already impaired at higher plasma glucose levels (3.6 and 3.1 mmol/l; respectively). Collectively, data of the Stroop task indicate that the control of attention via executive mechanisms is less sensitive to insulin-induced hypoglycemia than pre-attentive automated stimulus processing (reading, naming). If executive control of attention becomes affected by hypoglycemia, cognitive resources appear to be preferentially allocated to the processing of food stimuli.