STUDIES IN HYPOGLYCEMIA IN CHILDREN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Hypoglycaemia is the most important acute side effect of insulin thera py for diabetes in children. In general, children have more vigorous c ounterregulatory hormone responses to hypoglycaemia than adults. Child ren with diabetes may lose their glucagon responses to a falling blood glucose but persistence of brisk catecholamine, cortisol and growth h ormone responses, coupled with the insulin resistance natural to puber ty, may contribute to unstable diabetes control. Despite this, there i s some evidence that younger children may not experience or at least e xpress autonomic symptoms to the same degree as do adults. Furthermore , recurrent hypoglycaemia may induce defects in the counterregulatory responses and increase the risk of severe hypoglycaemia. Avoidance of moderate hypoglycaemia in clinical management may restore normal warni ng. There is research evidence to suggest that the human brain may be able to use non-glucose fuels to support its metabolism and function d uring hypoglycaemia but this is not yet translatable into clinical pra ctice and care to avoid hypoglycaemia in daily life remains the patien ts' best protection.