[Severe hypoglycemia in children and adolescents with type 1 diabetes: risks factors and management]

Hypoglycemia is one of the most common acute complications in the treatment of type 1 diabetes. It is the result of a mismatch between insulin dose, food consumed, and recent exercise. Hypoglycemia occurs more frequently in younger children and with lower HbA1c levels. Symptoms of hypoglycemia result from autonomic (adrenergic) activation and/or neurological dysfunction (neuroglycopenia). Severe hypoglycemia means that the child is having altered mental status and cannot assist in his care, is semiconscious or unconscious, or in coma--convulsions and may require parenteral therapy (glucagon or i.v. glucose). The blood glucose threshold for symptoms may be affected by antecedent hypoglycemia, duration of diabetes with decrease in neurohormonal counterregulatory responses. This phenomenon is termed hypoglycemia unawareness and is an important cause of severe hypoglycemia. Fortunately, there is absence of adverse effects of severe hypoglycemia on cognitive function in children with diabetes over 18 months, even if some controversies exist. Severe hypoglycemia is rapidly reversed by injection of glucagon 0.5 mg if < 25 kg, 1.0 mg if > 25 kg. In the hospital, intravenous infusion of glucose should be administered, e.g. glucose 10%, 2-5 mg/kg/min (1.2-3.0 ml/kg).