LACK OF RELATIONSHIP BETWEEN HYPOGLYCEMIC AWARENESS AND CATECHOLAMINE (CAT) RESPONSE IN INSULIN DEPENDENT DIABETES (IDD)

Abstract

We assessed hypoglycemic symptoms in 29 children aged 15.4±2.4 yrs (x±SD) with IDD duration 7.9±3.7 yrs. without clinical evidence of autonomic neuropathy. An intravenous insulin bolus of 0.15-0.75 u/kg according to basal plasma glucose (PG) was given before and again after 3 days of intensive insulin therapy (IIT). Oral questionnaires regarding hypoglycemic symptoms were completed at each time blood samples were taken for measurements of PG and CATS. A hypoglycemic awareness score (HAS) was assigned to each patient. All but one patient reported symptoms during each test. These occurred prior to hypoglycemia (PG>65 mg%) in 73% before and 52% after IIT. The initial symptoms (usually hunger) appeared at 38±26 min. before and 35±18 min. after IIT after PG decrements of 121±81 (47±28%) and 88±64 mg% (46±26%) resp. (NS). The CAT increments at this time were very small (174±55, range 0-802 and 70±89, 0-262 pg/ml resp.). The maximum HAS correlated negatively with PG nadir, before (r=-.69, p 250 pg/ml. Thus hypoglycemic unawareness is not common in children with IDD and symptoms occur prior to the onset of hypoglycemia with minimal if any CAT increments.