Related Experiment Videos
Severe hypoglycemia in insulin-dependent diabetic children treated by multiple injection insulin regimen
A Verrotti1, F Chiarelli, A Blasetti
1Department of Pediatrics, Ospedale Pediatrico, Chieti, Italy.
Insights
Severe hypoglycemia in children and adolescents on multiple daily insulin injections is often recurrent. A history of severe hypoglycemia predicts future episodes, independent of metabolic control or long-term complications.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Severe hypoglycemia is a significant concern in pediatric diabetes management.
- Multiple daily injection (MDI) regimens are common for children and adolescents with type 1 diabetes.
Purpose of the Study:
- To analyze the occurrence and risk factors of severe hypoglycemic attacks in pediatric patients on MDI therapy.
- To identify predictors of recurrent severe hypoglycemia in this population.
Main Methods:
- A 4-year retrospective study of children and adolescents using human insulin with MDI (3-4 injections/day).
- Comparison of patients with at least one severe hypoglycemic episode to a non-hypoglycemic control group (n=217).
- Analysis of insulin dosage, prior hypoglycemia history, age, sex, disease duration, metabolic control, and microvascular complications.
Main Results:
- 29 patients experienced severe hypoglycemia; 13 had recurrent episodes.
- Hypoglycemic patients received significantly higher insulin doses (1.05 U/kg/day vs 0.87 U/kg/day).
- A history of severe hypoglycemia was a strong predictor of future episodes (0.98 vs 0.26 episodes).
- No significant differences were found in age, sex, disease duration, metabolic control, or microvascular complications.
Conclusions:
- Severe hypoglycemia is a recurrent issue in pediatric diabetes treated with MDI.
- Past severe hypoglycemia is a key risk factor for future events.
- Recurrence is not linked to metabolic control quality or established microvascular complications.
Abstract:
The occurrence and risk factors of severe hypoglycemic attacks were analyzed during a 4-year study in a group of children and adolescents who received human insulin and followed a multiple daily injection regimen (three or four injections per day); 29 patients experienced severe hypoglycemia at least once in 4 years. Of these, 13 suffered recurrent episodes: 8 had two episodes, 4 had four episodes, and 1 patient had seven episodes. For comparative purposes, the nonhypoglycemic population (217 diabetic children) was used as a control group. The hypoglycemic children received insulin doses which were significantly higher than for nonhypoglycemic patients (1.05 +/- 0.6 U/kg daily vs 0.87 +/- 0.7; P < 0.05). Moreover, the hypoglycemic group had a significantly higher mean number of previous episodes of severe hypoglycemia than the nonhypoglycemic group (0.98 +/- 1.2 vs 0.26 +/- 0.7; P < 0.001). There was no significant difference in age, sex, duration of disease, and metabolic control between hypoglycemic and nonhypoglycemic children. There was no association between severe hypoglycemia and the presence of retinopathy, persistent microalbuminuria, or autonomic neuropathy. Severe hypoglycemia is a recurrent problem, not related to the quality of metabolic control nor to the presence of long-term microvascular complications, and diabetic children with a personal history of severe hypoglycemia are at risk for future episodes.