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Prediction and management of nocturnal hypoglycaemia in diabetes
Insights
Bedtime blood glucose monitoring in children with diabetes can predict nocturnal hypoglycemia. A small carbohydrate snack at bedtime can prevent these dangerous low blood sugar events in at-risk children.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Nocturnal hypoglycemia is a significant concern in children with diabetes, particularly those on insulin therapy.
- Predicting and preventing these events is crucial for maintaining glycemic control and patient safety.
Purpose of the Study:
- To identify predictors of nocturnal hypoglycemia in children with diabetes.
- To evaluate the efficacy of a bedtime carbohydrate snack in preventing nocturnal hypoglycemia.
Main Methods:
- 102 children with diabetes had blood glucose measured at 2200, 0200, and 0800 h.
- Predictive value modeling was used to assess blood glucose levels as predictors of nocturnal hypoglycemia.
- A controlled trial randomized children with a 2200 h glucose < 7 mmol/l to receive a carbohydrate snack or not.
Main Results:
- Nocturnal hypoglycemia occurred in 34% of children on twice-daily insulin vs. 10% on once-daily insulin.
- A blood glucose < 7 mmol/l at 2200 h was the best predictor of nocturnal hypoglycemia (sensitivity 63%, specificity 94%).
- A carbohydrate snack significantly reduced the incidence of nocturnal hypoglycemia in at-risk children.
Conclusions:
- Bedtime blood glucose measurement is a valuable tool for predicting nocturnal hypoglycemia in children with diabetes on twice-daily insulin.
- A simple carbohydrate snack can effectively prevent nocturnal hypoglycemia in children identified as being at risk.
Abstract:
Blood glucose measurements were made at 2200, 0200, and 0800 h in 102 children with diabetes during a 24 hour planned admission to hospital. Nocturnal hypoglycaemia (less than 3.0 mmol/l) occurred in 24 of 71 (34%) children on twice daily insulin and in three of 31 (10%) children on once daily insulin. Predictive value modelling showed that a blood glucose concentration of less than 7 mmol/l at 2200 h was the best predictor of nocturnal hypoglycaemia, with a sensitivity of 63%, specificity of 94%, and positive and negative predictive values of 83%. Blood glucose measurement at 0800 h had no predictive value for nocturnal hypoglycaemia. The mean (SD) glycosylated haemoglobin concentration of children on twice daily insulin who had nocturnal hypoglycaemia was 55 (8) mmol HMF/mol Hb, which was significantly less than that of children on twice daily insulin who did not have hypoglycaemia (64 (11) mmol HMF/mol Hb) or those on once daily insulin (62 (11) mmol HMF/mol Hb). A controlled trial was then performed in which 29 children with diabetes who had a blood glucose concentration at 2200 h of less than 7 mmol/l measured by Reflocheck were randomised into two groups, one of which received 10 g carbohydrate supplement and the other of which did not. Thirteen of the 14 children in the control group had hypoglycaemia at 0200 h, whereas the snack prevented hypoglycaemia in 12 of 15 in the test group. Blood glucose values in the two groups at 0800 h were similar. We conclude that bedtime glucose measurement in children on twice daily insulin is a useful predictor for nocturnal hypoglycaemia, which can be prevented by a small carbohydrate snack in those at risk.