SYMPTOMS OF HYPOGLYCEMIA IN CHILDREN AND ADOLESCENTS WITH TYPE-1 DIABETES-MELLITUS

Introduction and methods: The occurrence of hypoglycaemic symptoms in childhood was evaluated in 23 adolescents with insulin dependent diabe tes mellitus by inducing mild hypoglycaemia in the presence of their p arents. The procedure was approved by the local Ethics Committee. The objektive symptoms of hypoglycaemia were analysed by a symptom score f or autonomic and neuroglycopenic symptoms of hypoglycaemia. Glucose le vels were determined using a standard hexokinase method and catecholam ine levels were measured radioenzymatically. A radioimmunoassay was us ed to estimate isoprenaline-induced cAMP levels in lymphocytes. Result s: Only 34,8% of the patients had the typical early autonomic symptoms of hypoglycaemia, whereas 65,2% recognised neuroglycopenic symptoms o f hypoglycaemia only or no symptoms at all. The occurrence of early au tonomic symptoms decreased with the duration of diabetes whereas no ch ange was found for neuroglycopenic symptoms. Only two patients with re current episodes of nocturnal hypoglycaemia but 9 of the parents recog nised hypoglycaemia too late or not at all. Patients with recurrent ep isodes of anamnestic hypogly caemia showed significantly diminished hy poglycaemia-induced adrenaline release and cAMP accumulation compared to adolescents without hypoglycaemia. Patients with neuroglycopenic sy mptoms of hypoglycaemia had significantly diminished cAMP accumulation compared to those with autonomic symptoms. Conclusion: Recurrent epis odes of anamnestic hypoglycaemia are a main cause for frequent occurre nce of hypoglycaemia unawareness in childhood diabetes mellitus. The d esensitisation of adrenergic signal transduction may be an additional factor in the pathogenesis of hypoglycaemia unawareness. The parents o f diabetic children and adolescents should regularly be trained with r espect to the detection of hypoglycaemia symptoms.