COUNTERREGULATORY HORMONE AND SYMPTOM RESPONSES TO HYPOGLYCEMIA IN DIABETIC CHILDREN

The hormonal responses to, and symptoms of, hypoglycaemia were investi gated in 19 diabetic children (mean age 14.2 (SD 1.4) years, mean HbA( 1c) 9.8 (SD 1.2) %) and 16 non-diabetic children (14.4(1.0) years) dur ing a gradual reduction in plasma glucose with the glucose clamp techn ique. Plasma glucose was reduced from similar to 5.7 to similar to 2.6 mmol l(-1) in the diabetic children and from similar to 5.7 to simila r to 2.9 mmol l(-1) in the non-diabetic children over 200 min. The mea n glycaemic thresholds for adrenaline, and for autonomic and total sym ptom score, were similar in the diabetic and non-diabetic groups, and were found at plasma glucose levels between 3.4 and 3.7 mmol l(-1). Th e mean glucose levels which elicited increase of cortisol, growth horm one, and glucagon were tower (p < 0.01), and the mean incremental resp onses of adrenaline, cortisol, and glucagon were smaller in the diabet ic than in the non-diabetic children. In the diabetic children, a corr elation was found between Body Mass Index (BMI) and the hypoglycaemic thresholds for autonomic and total symptom scores (r = 0.64, p < 0.01 and r = 0.72, p = 0.001, respectively). We conclude that counterregula tory hormone responses are attenuated in diabetic as compared to non-d iabetic children, whereas recognition of autonomic symptoms is similar in the two groups. Diabetic children with a higher BMI seem to have i ncreased awareness of a declining plasma glucose level.