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Overnight metabolic profiles in very young insulin-dependent diabetic children
Insights
Very young children with diabetes mellitus experience a significant "dawn phenomenon," leading to poor blood glucose control. This study suggests improved glycemic management may be possible with more stable, early morning insulin levels, potentially via continuous subcutaneous insulin infusion.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- The metabolic control in very young children with diabetes mellitus is often disturbed but poorly studied.
- Limited data exists due to challenges in obtaining control data and lack of alternative therapies.
Purpose of the Study:
- To collect overnight metabolic data in very young children (under 6 years) with diabetes mellitus on standard injection therapy.
- To investigate the relationship between insulin levels and glucose control during the early morning hours.
Main Methods:
- Overnight metabolic profiles were collected from 9 children with diabetes mellitus.
- Frequent blood samples were analyzed for free insulin, glucose, alanine, lactate, glycerol, and 3-hydroxybutyrate.
- Distribution-free statistical analysis was used to correlate insulin and glucose changes.
Main Results:
- All children exhibited a pronounced "dawn phenomenon," with a steep rise in blood glucose between 04:30 and 09:30.
- Changes in intermediary metabolites indicated that insufficient insulin caused the glucose rise.
- Statistical analysis suggested a 2-6 hour delay between drops in free insulin and their effect on blood glucose.
Conclusions:
- A clear "dawn phenomenon" contributes to poor glycemic control in very young diabetic children.
- Achieving more stable and higher early morning insulin concentrations, possibly through continuous subcutaneous insulin infusion, could improve glycemic control.
Unlabelled:
The magnitude of the disturbance of metabolic control in diabetes mellitus in very young children has been recognised, but seldom studied. Limitations to studies are set by the difficulty of obtaining control data and until recently the lack of alternative therapies. Recently "mini" pumps for continuous subcutaneous insulin delivery have become available and may offer an alternative therapeutic possibility. The present investigation has been undertaken to collect overnight metabolic data of very young diabetic children (less than 6 years) controlled by standard injection therapy. During one admission to hospital frequent blood samples were collected for free insulin, glucose, alanine, lactate, glycerol and 3-hydroxybutyrate determinations. In all children (n = 9) the profiles showed a steep rise in glucose from 04.30 h (6.2 +/- 1.3 mmol/l) to 09.30 h (17.8 +/- 2.4 mmol/l) (the so-called "dawn-phenomenon"). The nature of the changes in the intermediary metabolites suggested that rise in blood glucose was caused by insufficient insulin. We have attempted to explore the time relationship between the overnight drop in free insulin levels and the rises in blood glucose by a distribution-free statistical analysis, correlating successive changes in time between the two profiles. The analysis suggested a delay of 2-6 h between free insulin levels and their effects.
In Conclusion:
a clear "dawn phenomenon" is seen in very young diabetic children, and contributes to their poor glycaemic control. More stable and higher insulin concentrations in the early morning, obtained perhaps by continuous subcutaneous insulin infusion, might ameliorate the overall glycaemic control in the very young diabetic child.