SEVERE HYPOGLYCEMIA IN INSULIN-DEPENDENT DIABETIC CHILDREN TREATED BYMULTIPLE INJECTION INSULIN REGIMEN

The occurrence and risk factors of severe hypoglycemic attacks were an alyzed during a 4-year study in a group of children and adolescents wh o received human insulin and followed a multiple daily injection regim en (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 populati on (217 diabetic children) was used as a control group. The hypoglycem ic children received insulin doses which were significantly higher tha n 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 me an number of previous episodes of severe hypoglycemia than the nonhypo glycemic group (0.98+/-1.2 vs 0.26+/-0.7; P<0.001). There was no signi ficant difference in age, sex, duration of disease, and metabolic cont rol between hypoglycemic and nonhypoglycemic children. There was no as sociation between severe hypoglycemia and the presence of retinopathy, persistent microalbuminuria, or autonomic neuropathy. Severe hypoglyc emia is a recurrent problem, not related to the quality of metabolic c ontrol nor to the presence of long-term microvascular complications, a nd diabetic children with a personal history of severe hypoglycemia ar e at risk for future episodes.