ESPE Abstracts (2015) 84 P-3-725

Frequent and Prolonged Daytime Hypoglycemia in Diabetic Children Detected by Continuous Glucose Monitoring: A Problem of Hypoglycaemia Unawareness?

Sara Bachmann, Kerstin Metzger, Melanie Hess & Urs Zumsteg


University Children’s Hospital, Basel, Switzerland


Background: Hypoglycaemia represents a common issue in diabetic children, and the achievement of good metabolic control together with the avoidance of hypoglycemia remains a tightrope walk. As hypoglycaemia is not always recognised, data about hypoglycemia frequency are limited.

Aims: We previously reported about nocturnal hypoglycaemia in diabetic children. This study now focusses on the frequency and duration of hypoglycemia at daytime and risk factors for such episodes.

Patients and methods: 60 diabetic children were included. The data of 51 patients (29 males, 22 females, mean age 12.1 years, 2.4–17.6 years, 36 with multiple insulin injection therapy and 15 on insulin pump) could be analysed. Glucose was measured by continuous glucose monitoring (CGMS) (iPro®, Medtronic) for 6 days. Subjects had to perform four blood glucose measurements per day for calibration and to keep notes about insulin doses, bed time and wake up time and symptoms of hypoglycaemia. HbA1c was calculated as average of four values measured preceding the study. Daytime hypoglycemia was defined as glucose excursion <3.7 mmol/l during daytime.

Results: Hypoglycaemia remains frequent in diabetic children, and most of the episodes are asymptomatic and often prolonged. Tight metabolic control or high insulin dosage however did not increase the risk for hypoglycaemia. In contrast longer diabetes duration could be identified as a risk factor for prolonged hypoglycaemia. These data suggest that hypoglycemia unawareness and decreasing counterregulation are a relevant problem already in childhood.

Conclusion: Hypoglycaemia remains frequent in diabetic children, and most of the episodes are asymptomatic and often prolonged. Tight metabolic control or high insulin dosage however did not increase the risk for hypoglycaemia. In contrast longer diabetes duration could be identified as a risk factor for prolonged hypoglycaemia. These data suggest that hypoglycaemia unawareness and decreasing counterregulation are a relevant problem already in childhood.

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