HYPOGLYCEMIA IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

Abstract

Background: Hypoglycemia represents the most frequent acute complication which occurs in type 1 diabetes mellitus. The importance of hypoglycemia in the practice of pediatrics is given by the impact on neural development. The objective of this study is to identify the main factors which predict the sudden drop of glycemia – modifiable factors which may represent therapeutic targets for the prevention of this acute complication of diabetes mellitus. Material and method: The study included 52 children with type 1 diabetes mellitus, hospitalized in the Clinic III of Pediatrics, the “Sf. Maria” Emergency Clinical Hospital for Children, from Iasi, over the period January 2009 – December 2010. The inclusion criteria were: the diagnosis of severe hypoglycemia upon hospitalization; nocturnal hypoglycemia during hospitalization. The glycemia of the patients was monitored and they were assessed from the perspective of clinical (age, sex, duration of diabetes mellitus) and paraclinical (quality of long term glycemic control, insulin dose for 24 hours, insulin treatment scheme) parameters that may be involved in the occurrence of hypoglycemia. Results: Of the 52 patients with type 1 diabetes mellitus, 18 children suffered from severe hypoglycemia, whereas the other 34 children presented hypoglycemic episodes of moderate or mild intensity. The severity of hypoglycemia depends on the duration of diabetes mellitus, the degree of metabolic control and age. There were no statistically significant differences with regard to the patients’ sex. As concerns the necessary dose of insulin, there was no statistically significant difference between the two groups, but the closest correlation with insulin is related to the number of injections per day (p<0.05). The prevalence of nocturnal hypoglycemia was 47%, of which 39% were symptomatic. The risk factors of nocturnal hypoglycemia were: at least two episodes of severe hypoglycemia from the onset of diabetes mellitus; insulin in a dose with >0.85 U/kilo body/day; over 5% of the measurements of glycemia ≤60 mg/dl during the last month of monitoring. The risk decreased with the age. Highly predictive values, with a relatively significant risk, were the threshold values of glycemia ≤90 mg/dl at dinner and ≤120 mg/dl at 7.00 AM. Conclusions: The recurrence of severe hypoglycemia in children with type 1 diabetes mellitus is determined by age, the duration of diabetes mellitus, long term glycemic control. The prediction is important for the increase of the quality of life of these patients and for the improvement of psychosocial comfort.