Abstract
We assessed hypoglycemic symptoms in 29 children aged 15.4±2.4 yrs (x±SD) with IDD duration 7.9±3.7 yrs. without clinical evidence of autonomic neuropathy. An intravenous insulin bolus of 0.15-0.75 u/kg according to basal plasma glucose (PG) was given before and again after 3 days of intensive insulin therapy (IIT). Oral questionnaires regarding hypoglycemic symptoms were completed at each time blood samples were taken for measurements of PG and CATS. A hypoglycemic awareness score (HAS) was assigned to each patient. All but one patient reported symptoms during each test. These occurred prior to hypoglycemia (PG>65 mg%) in 73% before and 52% after IIT. The initial symptoms (usually hunger) appeared at 38±26 min. before and 35±18 min. after IIT after PG decrements of 121±81 (47±28%) and 88±64 mg% (46±26%) resp. (NS). The CAT increments at this time were very small (174±55, range 0-802 and 70±89, 0-262 pg/ml resp.). The maximum HAS correlated negatively with PG nadir, before (r=-.69, p<.001) but not after IIT. The max HAS correlated with peak CAT response before (r=.42, p<.05) and after (r=0.42, p<.05) IIT. In patients with PG nadir <65 mg%, there were no differences in HAS or glucose recovery before and after IIT despite the fact that CAT response was significantly lower after IIT with some patients never achieving an increment >250 pg/ml. Thus hypoglycemic unawareness is not common in children with IDD and symptoms occur prior to the onset of hypoglycemia with minimal if any CAT increments.
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Hoffman, R., Singer-Cranick, C. & Becker, D. LACK OF RELATIONSHIP BETWEEN HYPOGLYCEMIC AWARENESS AND CATECHOLAMINE (CAT) RESPONSE IN INSULIN DEPENDENT DIABETES (IDD). Pediatr Res 21 (Suppl 4), 342 (1987). https://doi.org/10.1203/00006450-198704010-01050
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DOI: https://doi.org/10.1203/00006450-198704010-01050