Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr

Authors

  • Frida Sundberg,

    Corresponding author
    1. Diabetes Unit, Department of Pediatrics, Sahlgrenska Academy, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, SE 41685, Gothenburg, Sweden
    • Corresponding author:Frida Sundberg, MD,

      Diabetes Unit, Department of Pediatrics,

      The Queen Silvia Children's Hospital/Sahlgrenska University Hospital,

      SE 416 85 Gothenburg, Sweden.

      Tel: +46 31 34 34 000;

      fax: + 46 31 215 291;

      e-mail: frida.sundberg@vgregion.se

    Search for more papers by this author
  • Gun Forsander

    1. Diabetes Unit, Department of Pediatrics, Sahlgrenska Academy, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, SE 41685, Gothenburg, Sweden
    Search for more papers by this author

Abstract

Background

Mild hypoglycemia is commonly observed in children treated for type 1 diabetes mellitus (T1DM). Hypoglycemia disturbs cognition and learning.

Objective

To describe how and to what extent hypoglycemia in young children with T1DM is detected in everyday life. To learn how parents and caregivers treat hypoglycemia and to evaluate how efficient this treatment is.

Methods

Twenty-three children [12 girls, mean age: 4.5 yr, mean HbA1c: 59 mmol/mol (7.5%)], 17 of whom were treated with an insulin pump, underwent blinded continuous glucose monitoring (CGM). Data on symptoms and treatment of hypoglycemia were collected in a logbook. Plasma glucose values were collected through self-monitoring of blood glucose and entered in the logbook, and glucometer memories were uploaded. Data were collected during 1 wk in autumn and 1 wk in spring.

Results

Only 32% of all hypoglycemic events were detected despite plasma glucose being checked 10 times per day. Most hypoglycemic events were asymptomatic (90% overall and 98% of those occurring at night). Untreated hypoglycemic events were associated with a relapse into hypoglycemia within 3 h in the majority of events. Compared to treatment of hypoglycemia events with a defined dose of simple carbohydrates, treatment with a mixed meal resulted in a significantly higher glucose value 1 and 2 h after the hypoglycemia.

Conclusion

For optimum treatment, children younger than 7 yr with T1DM need better strategies and support for detecting hypoglycemia with real-time CGM. Hypoglycemia should be treated with a defined dose of carbohydrates rather than a mixed meal.

Ancillary