Insight into hypoglycemia in pediatric type 1 diabetes mellitus

Abstract

Hypoglycemia is a common complication of insulin treatment in type 1 diabetes mellitus and can occur in any patient with diabetes when glucose consumption exceeds supply. Many studies have been done to elucidate those factors that predict severe hypoglycemia: younger age, longer duration of diabetes, lower HgbA1c, higher insulin dose, lower Body Mass Index, male gender, Caucasian race, underinsurance or low socioeconomic status, and the presence of psychiatric disorders. Hypoglycemia can affect patients' relationships, occupation, and daily activities such as driving. However, one of the greatest impacts is patients' fear of severe hypoglycemic events, which is a limiting factor in the optimization of glycemic control. Therefore, the importance of clinicians’ ability to identify those patients at greatest risk for hypoglycemic events is two-fold: 1) Patients at greatest risk may be counseled as such and offered newer therapies and monitoring technologies to prevent hypoglycemic events. 2) Patients at lower risk may be reassured and encouraged to improve their glycemic control. Since the risk of long-term complications with poor blood glucose control outweighs the risks of hypoglycemia with good blood glucose control, patients should be encouraged to aim for glucose concentrations in the physiologic range pre- and post-prandially. Advancements in care, including multiple daily injection therapy with analog insulin, continuous subcutaneous insulin infusion, and continuous glucose monitoring, have each subsequently improved glycemic control and decreased the risk of severe hypoglycemia.

Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange

“…The glycemic thresholds at which these symptoms occur, as well as the severity with which they manifest themselves, may vary in individuals with type 1 diabetes depending on the number of hypoglycemic episodes they have experienced ( 31 – 33 ). Counterregulatory physiological responses may evolve in patients with type 1 diabetes who endure repeated hypoglycemia over time ( 34 , 35 ).…”

How does a predictive low glucose suspend (PLGS) system tackle pediatric lifespan challenges in diabetes treatment? Real world data analysis

“…Unfortunately, the unpredictability of hypoglycemia is still a major problem. There are a number of everyday life situations where children are not aware of lower blood glucose which can cause damage in the long run . This hypoglycemia unawareness reduces adherence to insulin treatment and makes patients accustomed to hypoglycemic stress, reducing their capacity to react to hypoglycemia …”

The role of continuous glucose monitoring in the care of children with type 1 diabetes

“…Fear of hypoglycemia limits many children from attaining desired HbA1c goals [29]. For many children with T1D, bedtime blood glucose checks are poor predictors of nocturnal hypoglycemia [10,11,30].…”