Abstract
To determine wheter immature or defective glucose CR was responsible of the severe recurrent hypoglycemia (3, 6 per patient per yr) observed during CT in 6 preschool diabetic children, we investigated their metabolic and hormonal responses to iv insulin infusion (40 mU kg−1 hr−1). CR was considered adequate since no patient experienced symptoms requiring discontinuation of the test, and (BG) nadirs averaged 42 ± 5 mg/dl. Glucose production decreased from 4.2 ± 0.2 to 2.6 ± 0.6 mg kg−1 min−1. Blood 3-hydroxybutyrate levels were high (~ 3 mM) and did not change during the test. The responses of epinephrine (from 137 ± 37 to 393 ± 143 pg/ml), norepinephrine (from 145 ± 33 to 347 ± 152 pg/ml) and GH (from 6.0 - 1.5 to 20.3 - 5.1 ng/ml) were normal. As observed in diabetic adults, glucagon response was deficient (from 117 ± 30 to 114 ± 18 pg/ml).
The 6 children were subsequently treated with insulin pumps (CSII), which resulted in a 20 fold decrease of severe hypoglycemia. During this therapy, a significant inverse correlation appeared between the individual frequence of BG values below 40 mg/ dl and BG nadir during the insulin infusion test (r=-0.94, p<0.001)
We conclude that the glucose CR status evaluated by a simple standardized insulin infusion test reliably predicts the risk of developing hypoglycemia during CSII in young diabetic children.
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Bougnères, P., Brambilla, P., Chaussain, J. et al. GLUCOSE COUNTERREGULATION (CR) IN PRESCHOOL AGE DIABETIC CHILDREN WITH RECURRENT HYPOGLYCEMIA DURING CONVENTIONAL TREATMENT (CT). Pediatr Res 20, 1186 (1986). https://doi.org/10.1203/00006450-198611000-00074
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DOI: https://doi.org/10.1203/00006450-198611000-00074