Hypoglycemia in children with type 1 diabetes: unawareness is a concrete risk

Franchini, Simone; Comegna, Laura; Prezioso, Giovanni; Blasetti, Annalisa

doi:10.1080/03007995.2016.1185400

Cited by 6 publications

(6 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Children and adolescents using an isCGM should perform a scan at least twice during the nocturnal period (e.g. at 01:00 hours and 04:00 hours) due to the increased risk of nocturnal hypoglycaemia [101][102][103][104] (D), especially after exercise [81,[104][105][106] (D). Parents or other care providers can be alerted using the remote monitoring function within CGMs, which can support parents in their effort to avoid nocturnal hypoglycaemia in children [91] (D).…”

Section: Children and Adolescents With Type 1 Diabetesmentioning

confidence: 99%

Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

et al. 2020

View full text Add to dashboard Cite

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.

show abstract

Section: Children and Adolescents With Type 1 Diabetesmentioning

confidence: 99%

Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…When reaching this lower threshold, the guidance as shown in Table 7 can be followed and further individualised, if required. Children and adolescents using an isCGM should perform a scan at least twice during the nocturnal period (eg, at 01:00 hours and 04:00 hours) due to the increased risk of nocturnal hypoglycaemia [101][102][103][104](D), especially after exercise [81,[104][105][106](D). Parents or other care providers can be alerted using the remote monitoring function within CGMs, which can support parents in their effort to avoid nocturnal hypoglycaemia in children [91](D).…”

Section: Nocturnal Post-exercise Periodmentioning

confidence: 99%

Glucose management for exercise using continuous glucose monitoring ( CGM ) and intermittently scanned CGM ( isCGM ) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes ( EASD ) and of the International Society for Pediatric and Adolescent Diabetes ( ISPAD ) endorsed by
Moser
¹
,
Riddell
²
,
Eckstein
³

et al. 2020
Pediatric Diabetes
53
1
44
0
View full text Add to dashboard Cite

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.

show abstract

“…TIDM is a long-term disease frequently diagnosed during infancy and a 3-4% annual increase rate in children and adolescents has been estimated in Europe. 3,18 TIDM patients under strict insulin treatment can show one to two episodes per week of moderate hypoglycemia, which increases the risk for SH (one episode per year) due to a blunted counter-regulatory hormonal response and hypoglycemia unawareness. [1][2][3][4][5] Mild to moderate hypoglycemia has been described as blood glucose < 70 mg/dl and > 55 mg/dl without loss of consciousness, while SH is considered when blood glucose falls below 50 mg/dl, is accompanied by seizures, altered consciousness or coma and requires external assistance for treatment with carbohydrates or glucagon.…”

Section: Discussionmentioning

confidence: 99%

“…Although not an immediate threat, a repeated history of RH might cause cognitive dysfunction. 17,18 Studies show that RH in healthy animals induces synaptic alterations, oxidative stress and limited neuronal death in the cerebral cortex 13,19,20 and even improvement of spatial memory. [20][21][22] In diabetic animals, RH associates with increased cognitive deficit and oxidative damage, suggesting that diabetes exacerbates the damaging effects of hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

Recurrent moderate hypoglycemia exacerbates oxidative damage and neuronal death leading to cognitive dysfunction after the hypoglycemic coma

Languren

Montiel

Ramı́rez-Lugo

et al. 2017

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Moderate recurrent hypoglycemia (RH) is frequent in Type 1 diabetes mellitus (TIDM) patients who are under intensive insulin therapy increasing the risk for severe hypoglycemia (SH). The consequences of RH are not well understood and its repercussions on neuronal damage and cognitive function after a subsequent episode of SH have been poorly investigated. In the current study, we have addressed this question and observed that previous RH during seven consecutive days exacerbated oxidative damage and neuronal death induced by a subsequent episode of SH accompanied by a short period of coma, in the parietal cortex, the striatum and mainly in the hippocampus. These changes correlated with a severe decrease in reduced glutathione content (GSH), and a significant spatial and contextual memory deficit. Administration of the antioxidant, N-acetyl-L-cysteine, (NAC) reduced neuronal death and prevented cognitive impairment. These results demonstrate that previous RH enhances brain vulnerability to acute hypoglycemia and suggests that this effect is mediated by the decline in the antioxidant defense and oxidative damage. The present results highlight the importance of an adequate control of moderate hypoglycemic episodes in TIDM.

show abstract

Hypoglycemia in children with type 1 diabetes: unawareness is a concrete risk

Cited by 6 publications

References 50 publications

Recurrent moderate hypoglycemia exacerbates oxidative damage and neuronal death leading to cognitive dysfunction after the hypoglycemic coma

Contact Info

Product

Resources

About