155-LB: Counterregulatory Response to Hypoglycemia after Short-Term Use of Low and Very Low Carbohydrate Diets in Children with Type 1 Diabetes (T1D)

Abstract

Background: Low carbohydrate (CHO) diets are used to improve diabetes control, but the safety of these diets has not been studied in children. We assessed counterregulatory response to hypoglycemia after short-term low (LC) or very low (VLC) CHO diets in children with T1D. Methods: Epinephrine (epi), norepinephrine (NE), glucagon (gluc), and beta-hydroxybutyrate (BOHB) were measured before and immediately after becoming hypoglycemic at baseline and after 3 months on a LC or VLC diet (CHO made up 30-39% or 20-29% of total daily calories, respectively). 13 children were enrolled, mean (±SE) A1c 7.8±0.2%, diabetes duration 6.3±1.0 yrs. Participants were given sufficient insulin to decrease glucose to <60 mg/dL (<3.3 mmol/L). Continuous glucose monitoring (Dexcom® G5 or G6) was used to monitor glucose trends. Hypoglycemia was confirmed using a plasma glucose analyzer. Results: Mean age (±SE) for LC and VLC, 10.5±1.7 (n=7) and 15.0±0.6 yrs (n=6), respectively. Epi increased in response to hypoglycemia at baseline in both groups (mean±SE increase, pg/mL) (LC 130.9±60.1, p=0.072; VLC 412.6±84.0, p= 0.008). At 3 mos Epi increased in LC (181.6±66.7, p=0.053) but not significantly in VLC (100.2±67.9, p=0.214). The change in Epi in response to hypoglycemia was significantly less at 3 mos vs. baseline in VLC (100.2±67.9 vs. 412.6±84.0, p=0.019) but not in LC (181.6±66.7 vs. 191.4±61.7, p=0.935). Change in NE, gluc and BOHB during hypoglycemia was similar in both groups when comparing 3 months of diet with baseline. There was no effect of diet when comparing baseline and 3-month changes in Epi, NE, gluc and BOHB in response to hypoglycemia. Conclusion: Short-term use of a diet very low in CHO in children with T1D may adversely affect counterregulatory response to hypoglycemia, whereas LC diet did not affect response. Further studies are needed to confirm these findings and to assess whether these diets affect growth and development in young children. Disclosure L. Fox: None. J. W. Permuy: None. D. Perez santiago: None. M. Fox: None. M. Hossain: None. Funding Nemours Research Programs; Dexcom, Inc.