Problems of Hypoglycemia Arising in Children and Adolescents with Insulin-Dependent Diabetes Mellitus

Hypoglycemic episodes were studied in two large populations of prepubertal (332 subjects, aged 6-11 years) and adolescent (200 subjects, aged 12-18 years) diabetic children. We confirmed the majority of published data on incidence and causes of hypoglycemia and added some new information on the complex symptomatology and fear of hypoglycemia. Longer duration of IDDM induced a change in the symptomatology of hypoglycemia, consisting of a reduced occurrence of autonomic symptoms, namely tremor, and a parallel increased experience of neuroglycopenic symptoms, particularly drowsiness, difficulty in concentrating, and lack of coordination. The latter symptoms were found more frequently in patients with partial unawareness, more severe episodes and higher fear of hypoglycemia. These observations draw attention to the neuroglycopenic symptoms as important warning cues of hypoglycemia. We emphasized the necessity of observing the change in the frequency of symptoms experienced by patients, in particular autonomic and neuroglycopenic symptoms, in order to educate patients to preserve a normal awareness of hypoglycemia and prevent severe episodes.

[1]  Correlates of hypoglycemic fear in type I and type II diabetes mellitus. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[2]  G. Soltész,et al.  Association between diabetes, severe hypoglycaemia, and electroencephalographic abnormalities. , 1989, Archives of disease in childhood.

[3]  D. Goldstein,et al.  A Prospective Study of Symptomatic Hypoglycemia in Young Diabetic Patients , 1981, Diabetes Care.

[4]  A. Schiffrin,et al.  Severe Hypoglycemia in IDDM Children , 1989, Diabetes Care.

[5]  D. Cox,et al.  Perceived Symptoms in the Recognition of Hypoglycemia , 1993, Diabetes Care.

[6]  J. Ludvigsson,et al.  Severe Hypoglycemia in Children With IDDM: A prospective population study, 1992–1994 , 1997, Diabetes Care.

[7]  A. Drash,et al.  Cognitive deficits in adolescents who developed diabetes early in life. , 1985, Pediatrics.

[8]  D. Cox,et al.  Reduced Awareness of Hypoglycemia in Adults With IDDM: A prospective study of hypoglycemic frequency and associated symptoms , 1995, Diabetes Care.

[9]  P. Cryer,et al.  Hypoglycemia Unawareness in IDDM , 1993, Diabetes Care.

[10]  L. Madácsy,et al.  Autonomic dysfunction and severe hypoglycaemia in insulin dependent diabetes mellitus. , 1991, Archives of disease in childhood.

[11]  M. Egger,et al.  Increasing Incidence of Hypoglycemic Coma in Children With IDDM , 1991, Diabetes Care.

[12]  Diabetes Control.  Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. , 1994, The Journal of pediatrics.

[13]  F. Hermoso,et al.  Nocturnal hypoglycaemia in IDDM patients younger than 18 years , 1997, Diabetic medicine : a journal of the British Diabetic Association.

[14]  I. Deary,et al.  Symptoms of Acute Insulin-Induced Hypoglycemia in Humans With and Without IDDM: Factor-Analysis Approach , 1991, Diabetes Care.

[15]  J. Åman,et al.  Symptomatic Hypoglycaemia in Childhood Diabetes: A Population‐Based Questionnaire Study , 1989, Diabetic medicine : a journal of the British Diabetic Association.

[16]  D. Daneman,et al.  Severe hypoglycemia in children with insulin-dependent diabetes mellitus: frequency and predisposing factors. , 1989, The Journal of pediatrics.

[17]  I. Deary,et al.  Classification of Symptoms of Hypoglycaemia in Insulin‐treated Diabetic Patients Using Factor Analysis: Relationship to Hypoglycaemia Unawareness , 1992, Diabetic medicine : a journal of the British Diabetic Association.

[18]  G Nowacek,et al.  Fear of Hypoglycemia: Quantification, Validation, and Utilization , 1987, Diabetes Care.

[19]  V. Bhatia,et al.  Severe hypoglycemia in youth with insulin-dependent diabetes mellitus: frequency and causative factors. , 1991, Pediatrics.

[20]  D. Cox,et al.  The frequency of severe hypoglycaemia in children with insulin-dependent diabetes mellitus. , 1996, Hormone research.

[21]  C. Binder,et al.  Symptomatic Hypoglycaemia in 411 Type 1 Diabetic Patients , 1991, Diabetic medicine : a journal of the British Diabetic Association.

[22]  P. Macfarlane,et al.  A Prospective Study of Symptomatic Hypoglycaemia in Childhood Diabetes , 1989, Diabetic medicine : a journal of the British Diabetic Association.

[23]  P. Brambilla,et al.  Glucose Counterregulation in Pre-School-Age Diabetic Children With Recurrent Hypoglycemia During Conventional Treatment , 1987, Diabetes.

[24]  N. Fineberg,et al.  Fear of Hypoglycemia in the Parents of Children and Adolescents With Diabetes: Maladaptive or Healthy Response? , 1997, The Diabetes educator.

[25]  D. Ewing,et al.  Unawareness of Hypoglycaemia in Insulin‐treated Diabetic Patients: Prevalence and Relationship to Autonomic Neuropathy , 1990, Diabetic medicine : a journal of the British Diabetic Association.

[26]  G. Soltész,et al.  Hypoglycaemia in the diabetic child. , 1993, Bailliere's clinical endocrinology and metabolism.

[27]  Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. , 1991, The American journal of medicine.

[28]  Philip Hougaard,et al.  Comparison of Metabolic Control in a Cross-Sectional Study of 2,873 Children and Adolescents With IDDM from 18 Countries , 1997, Diabetes Care.

[29]  T. Jones,et al.  Hypoglycemia: Incidence and Clinical Predictors in a Large Population-Based Sample of Children and Adolescents with IDDM , 1997, Diabetes Care.

[30]  P. Cryer,et al.  Induction of Hypoglycemia Unawareness by Asymptomatic Nocturnal Hypoglycemia , 1993, Diabetes.

[31]  D. Cox,et al.  Psychobehavioral Metabolic Parameters of Severe Hypoglycemic Episodes , 1990, Diabetes Care.

[32]  I. Deary,et al.  Symptoms of Hypoglycemia in Children With IDDM , 1995, Diabetes Care.

[33]  P. Perrotta,et al.  Computer based instruction of diabetic children and adolescents. Techniques and results. , 1989, Journal of endocrinological investigation.

[34]  T. Jones,et al.  Incidence and predictive criteria of nocturnal hypoglycemia in young children with insulin-dependent diabetes mellitus. , 1997, The Journal of pediatrics.

[35]  R. Ehrlich,et al.  Intellectual Deficits Associated With Early Onset of Insulin-Dependent Diabetes Mellitus in Children , 1987, Diabetes Care.

[36]  C. Limbert,et al.  Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors. , 1993, Journal of diabetes and its complications.