Hypoglycemia, Hypoglycemia unawareness and counterregulation in children and adolescents with type I diabetes Mellitus

Bober E., Buyukgebiz A., Verrotti A., Chiarelli F.

JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, cilt.18, sa.9, ss.831-841, 2005 (SCI-Expanded) identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 18 Sayı: 9
  • Basım Tarihi: 2005
  • Dergi Adı: JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.831-841
  • Anahtar Kelimeler: hypoglycemia, children, type 1 diabetes mellitus, DEFECTIVE GLUCOSE COUNTERREGULATION, INTENSIVE INSULIN THERAPY, IMPROVED GLYCEMIC CONTROL, NOCTURNAL HYPOGLYCEMIA, ANTECEDENT HYPOGLYCEMIA, BLOOD-GLUCOSE, COGNITIVE FUNCTION, AUTONOMIC FAILURE, DEFICIENT COUNTERREGULATION, HORMONAL COUNTERREGULATION
  • Dokuz Eylül Üniversitesi Adresli: Hayır

Özet

Three clinical phenomena have been defined in the last decade in patients with diabetes mellitus as a dangerous iatrogenic sequel of hypoglycemia. These are hypoglycemia unawareness, defective glucose counterregulation and a lowered hypoglycemic threshold for hypoglycemic symptoms. Former mild hypoglycemia episodes cause a decrease and a delay in the protective hormonal counterregulatory response and warning symptoms in subsequent episodes, and in the absence of these, risk of severe hypoglycemia increases considerably. It has been demonstrated that when protection is provided against hypoglycemia with strict monitoring programs designed to avoid even mild hypoglycemia episodes, blunted autonomic symptoms and counterregulatory hormonal responses are rectified. Therefore, the best course of action in the treatment of pediatric diabetes mellitus is frequent blood sugar measurements, flexible multiple dose insulin regimens facilitating insulin dose adjustments as required, and a diet. In order to implement this, it is essential to organize an intensive training program with the patient and family, and to provide psychological support and close coordination with the diabetes treatment team.