GLUCOSE COUNTERREGULATION (CR) IN PRESCHOOL AGE DIABETIC CHILDREN WITH RECURRENT HYPOGLYCEMIA DURING CONVENTIONAL TREATMENT (CT)

Abstract

To determine wheter immature or defective glucose CR was responsible of the severe recurrent hypoglycemia (3, 6 per patient per yr) observed during CT in 6 preschool diabetic children, we investigated their metabolic and hormonal responses to iv insulin infusion (40 mU kg−1 hr−1). CR was considered adequate since no patient experienced symptoms requiring discontinuation of the test, and (BG) nadirs averaged 42 ± 5 mg/dl. Glucose production decreased from 4.2 ± 0.2 to 2.6 ± 0.6 mg kg−1 min−1. Blood 3-hydroxybutyrate levels were high (~ 3 mM) and did not change during the test. The responses of epinephrine (from 137 ± 37 to 393 ± 143 pg/ml), norepinephrine (from 145 ± 33 to 347 ± 152 pg/ml) and GH (from 6.0 - 1.5 to 20.3 - 5.1 ng/ml) were normal. As observed in diabetic adults, glucagon response was deficient (from 117 ± 30 to 114 ± 18 pg/ml).The 6 children were subsequently treated with insulin pumps (CSII), which resulted in a 20 fold decrease of severe hypoglycemia. During this therapy, a significant inverse correlation appeared between the individual frequence of BG values below 40 mg/ dl and BG nadir during the insulin infusion test (r=-0.94, p<0.001)We conclude that the glucose CR status evaluated by a simple standardized insulin infusion test reliably predicts the risk of developing hypoglycemia during CSII in young diabetic children.