Independent Effects of Youth and Poor Diabetes Control on Responses to Hypoglycemia in Children
Abstract
To evaluate the effects of childhood and poorly controlled insulin-dependent diabetes mellitus (IDDM) on counterregulatory hormone and symptomatic responses to hypoglycemia, we studied 16 nondiabetic children (13 ± 2 yr), 19 nondiabetic adults (26 ± 3 yr), and 13 children with IDDM (14 ± 2 yr, HbA1, 15.1 ± 3.3%) during a gradual reduction in plasma glucose with the glucose-clamp technique. Plasma glucose was reduced from ∼5 to ∼2.8 mM over 240 min with serial assessment of counterregulatory hormone levels and symptom awareness. The plasma glucose level that triggered a sustained rise in plasma epinephrine was consistently higher in nondiabetic children than in adults (3.9 ± 0.06 vs. 3.2 ± 0.06 mM, P < 0.001). Poorly controlled IDDM further elevated the glucose threshold for epinephrine release to normoglycemic levels (4.9 ± 0.2 mM, P < 0.001 vs. both control groups). Age and IDDM also produced an upward shift in the glucose level at which growth hormone release and symptom awareness were initiated. In contrast to the effect on glucose thresholds, maximal epinephrine responses and symptom scores were increased only by age and not IDDM (2-fold higher in children). We conclude that childhood and poor diabetes control independently contribute to an upward shift in glucose thresholds for counterregulatory hormone release and symptom awareness during mild hypoglycemia. Normoglycemic counterregulation may interfere with efforts to control diabetes in young patients.
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A total of 25 studies (40%) provided data to either calculate or extract the glycaemic threshold for symptom responses to hypoglycaemia.
“A total of 25 studies (40%) provided data to either calculate or extract the glycaemic threshold for symptom responses to hypoglycaemia [6, 13, 16–18, 20, 23, 24, 26, 29, 31, 33–37, 46, 51–53, 56, 57, 58, 63, 68].”
From Glycaemic thresholds for counterregulatory hormone and symptom responses to hypoglycaemia in people with and without type 1 diabetes: a systematic review (2022) · cites this paper as [17]
Two studies dating back to the 1990s that used a gradual glucose-lowering method to assess glycaemic thresholds in children with type 1 diabetes reported results in line with the systematic review's findings.
“Nevertheless, two studies dating back to the 1990s that used such a gradual glucose-lowering method to assess glycaemic thresholds in children with type 1 diabetes reported results that were in line with our findings [17, 18].”
From Glycaemic thresholds for counterregulatory hormone and symptom responses to hypoglycaemia in people with and without type 1 diabetes: a systematic review (2022) · cites this paper as [17]
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- Authors
- Jones, T. W., Boulware, S. D., Kraemer, D. T., Caprio, S., Sherwin, R. S., & Tamborlane, W. V.
- Affiliations
- Yale University (US)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1991-03-01
- Volume
- 40
- Issue
- 3
- Pages
- 358-363
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2088735076
- Cited by
- 85
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 4 · 2012: 3
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK20495)
- National Center for Research Resources (M01RR000125, RR00125, RR06022)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- type 1 diabetes, pediatric diabetes, hypoglycemia, counterregulatory hormones, epinephrine, growth hormone, glucose threshold, glycemic control, age differences
- MeSH terms
- Adolescent, Adult, Age Factors, Blood Glucose, Diabetes Mellitus, Type 1, Epinephrine, Glucagon, Glycated Hemoglobin, Humans, Hydrocortisone, Hypoglycemia, Insulin Infusion Systems, Reference Values, Growth Hormone, Glucose Clamp Technique
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