A sustained cognitive injury is also suggested based on: 1) the infrequent reports of immediate cognitive deficits following severe DKA (23); 2) the extended and increased systemic concentration of inflammatory cytokines even after correction of DKA (36); 3) the decreased density of neuroprotective GH and IGF-1 neuronal receptors in various brain regions including the hippocampus in DKA/CE (11,38,39), a region that is important for the formation and retrieval of numerous memory systems. Here, IGF1 is linked to Cognitive impairment.