Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Current Diabetes Reports
Published in: Current Diabetes Reports 9/2016

01-09-2016 | Treatment of Type 1 Diabetes (M Pietropaolo, Section Editor)

Management of Hypoglycemia in Children and Adolescents with Type 1 Diabetes Mellitus

Authors: Dayna E. McGill, Lynne L. Levitsky

Published in: Current Diabetes Reports | Issue 9/2016

Login to get access

Abstract

Hypoglycemia and fear of hypoglycemia limit appropriate glycemic control in many children and adolescents with type 1 diabetes. Traditional approaches to the prevention of hypoglycemia including patient education about modifiable risk factors for hypoglycemia (changes in insulin, diet, and exercise) and frequency of self glucose monitoring remain important for hypoglycemia prevention. Continuous glucose monitoring systems with or without a partial closed-loop control of insulin infusion have been very useful in the prevention of hypoglycemia. Oral carbohydrate and parenteral glucagon continue to be the mainstays of hypoglycemia treatment. In the future, we can look forward to regulatory approval of closed-loop insulin delivery and glucose monitoring systems to facilitate euglycemia, as well as glucagon administered by the intranasal route to treat hypoglycemia.
Literature
1.
Karges B, Kapellen T, Wagner VM, Steigleder-Schweiger C, Karges W, Holl RW, et al. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediat Diabetes 2015. doi:10.​1111/​pedi.​12348
2.
Barnard K, Thomas S, Royle P, Noyes K, Waugh N. Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review. BMC Pediatr. 2010;10:50.CrossRefPubMedPubMedCentral
3.
Johnson SR, Cooper MN, Davis EA, Jones TW. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents. Diabetic Med: J Br Diabetic Assoc. 2013;30:1126–31.CrossRef
4.
Freckleton E, Sharpe L, Mullan B. The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes. Int J Behav Med. 2014;21:804–10.CrossRefPubMed
5.
Arbelaez AM, Semenkovich K, Hershey T. Glycemic extremes in youth with T1DM: the structural and functional integrity of the developing brain. Pediatr Diabetes. 2013;14:541–53.CrossRefPubMed
6.
McNeilly AD, McCrimmon RJ. The Scylla and Charybdis of glucose control in childhood type 1 diabetes? Pediatr Diabetes. 2015;16:235–41.CrossRefPubMed
7.
Cameron FJ. The impact of diabetes on brain function in childhood and adolescence. Pediatr Clin N Am. 2015;62:911–27.CrossRef
8.
9.••
Mauras N, Mazaika P, Buckingham B, Weinzimer S, White NH, Tsalikian E, et al. Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia. Diabetes. 2015;64:1770–9. This paper suggests that chronic hyperglycemia is much more likely to induce neuroanatomic structural changes and congitive loss than hypoglycemia.CrossRefPubMed
10.
Marzelli MJ, Mazaika PK, Barnea-Goraly N, Hershey T, Tsalikian E, Tamborlane W, et al. Neuroanatomical correlates of dysglycemia in young children with type 1 diabetes. Diabetes. 2014;63:343–53.CrossRefPubMed
11.
Barnea-Goraly N, Raman M, Mazaika P, Marzelli M, Hershey T, Weinzimer SA, et al. Alterations in white matter structure in young children with type 1 diabetes. Diabetes Care. 2014;37:332–40.CrossRefPubMedPubMedCentral
12.
Hershey T, Perantie DC, Wu J, Weaver PM, Black KJ, White NH. Hippocampal volumes in youth with type 1 diabetes. Diabetes. 2010;59:236–41.CrossRefPubMed
13.
Perantie DC, Wu J, Koller JM, Lim A, Warren SL, Black KJ, et al. Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1 diabetes. Diabetes Care. 2007;30:2331–7.CrossRefPubMed
14.•
Wilson DM, Calhoun PM, Maahs DM, Chase HP, Messer L, Buckingham BA, et al. Factors associated with nocturnal hypoglycemia in at-risk adolescents and young adults with type 1 diabetes. Diabetes Technol Ther. 2015;17:385–91. This paper examines the correlates of nocturnal hypoglycemia with exercise and other behaviors.CrossRefPubMedPubMedCentral
15.
Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37:2034–54.CrossRefPubMed
16.••
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. J Clin Endocrinol Metab. 2013;98:1845–59. This consensus review discusses the etiology and prevention of hypoglycemia in people with diabetes across the lifespan.CrossRefPubMed
17.
McMahon SK, Ferreira LD, Ratnam N, Davey RJ, Youngs LM, Davis EA, et al. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab. 2007;92:963–8.CrossRefPubMed
18.
Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr. 2005;147:528–34.CrossRefPubMed
19.••
Metcalf KM, Singhvi A, Tsalikian E, Tansey MJ, Zimmerman MB, Esliger DW, et al. Effects of moderate-to-vigorous intensity physical activity on overnight and next-day hypoglycemia in active adolescents with type 1 diabetes. Diabetes Care. 2014;37:1272–8. This study confirms the effects of the timing of exercise on glycemia for a day or more.CrossRefPubMedPubMedCentral
20.
Gomez AM, Gomez C, Aschner P, Veloza A, Munoz O, Rubio C, et al. Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy. J Diabetes Sci Technol. 2015;9:619–24.CrossRefPubMedPubMedCentral
21.
Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr. 2010;157:784–8. e1.CrossRefPubMedPubMedCentral
22.
Tsalikian E, Kollman C, Tamborlane WB, Beck RW, Fiallo-Scharer R, Fox L, et al. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care. 2006;29:2200–4.CrossRefPubMed
23.••
Robertson K, Riddell MC, Guinhouya BC, Adolfsson P, Hanas R, ISPAD Clinical Practice Consensus Guidelines. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2014;15 Suppl 20:203–23. This consensus guideline discusses how to prevent and treat hypoglycemia associated with exercise in children.CrossRefPubMed
24.
Kaufman FR, Devgan S. Use of uncooked cornstarch to avert nocturnal hypoglycemia in children and adolescents with type I diabetes. J Diabetes Complicat. 1996;10:84–7.CrossRefPubMed
25.
Kaufman FR, Halvorson M, Kaufman ND. Evaluation of a snack bar containing uncooked cornstarch in subjects with diabetes. Diabetes Res Clin Pract. 1997;35:27–33.CrossRefPubMed
26.
Kaufman FR, Halvorson M, Kaufman ND. A randomized, blinded trial of uncooked cornstarch to diminish nocturnal hypoglycemia at diabetes camp. Diabetes Res Clin Pract. 1995;30:205–9.CrossRefPubMed
27.
Detlofson I, Kroon M, Aman J. Oral bedtime cornstarch supplementation reduces the risk for nocturnal hypoglycaemia in young children with type 1 diabetes. Acta Paediatr. 1999;88:595–7.CrossRefPubMed
28.
Moheet A, Mangia S, Kumar A, Tesfaye N, Eberly LE, Bai Y, et al. Naltrexone for treatment of impaired awareness of hypoglycemia in type 1 diabetes: a randomized clinical trial. J Diabetes Complicat. 2015;29:1277–82.CrossRefPubMed
29.
Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:1464–76.CrossRefPubMed
30.
Beck RW, Hirsch IB, Laffel L, Tamborlane WV, Bode BW, Buckingham B, et al. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care. 2009;32:1378–83.CrossRefPubMed
31.
Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med. 2013;369:224–32.CrossRefPubMed
32.
Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013;310:1240–7.CrossRefPubMed
33.•
Buckingham BA, Raghinaru D, Cameron F, Bequette BW, Chase HP, Maahs DM, et al. Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis. Diabetes Care. 2015;38:1197–204. Use of a partially closed loop insulin infusion and continuous glucose monitor reduces nocturnal hypoglycemia.CrossRefPubMedCentral
34.•
Russell SJ, Hillard MA, Balliro C, Magyar KL, Selagamsetty R, Sinha M, et al. Day and night glycaemic control with a bionic pancreas versus conventional insulin pump therapy in preadolescent children with type 1 diabetes: a randomised crossover trial. Lancet Diabetes Endocrinol 2016. Glycemic control is enhanced by bihormonal closed loop diabetes control in this study of a not regulatory-approved device.
35.
Zeigler C, Liberman A, Nimri R, Muller I, Klemencic S, Bratina N, et al. Reduced worries of hypoglycemia, high satisfaction, and increased perceived ease of use after experiencing four nights of MD-Logic artificial pancreas at home (DREAM4). J Diabetes Res. 2015;2015:590308. doi:10.​1155/​2015/​590308.
36.
Dehlinger K, Tarnowski K, House JL, Los E, Hanavan K, Bustamante B, et al. Can trained dogs detect a hypoglycemic scent in patients with type 1 diabetes? Diabetes Care. 2013;36:e98–9.CrossRefPubMedPubMedCentral
37.
Petry NM, Wagner JA, Rash CJ, Hood KK. Perceptions about professionally and non-professionally trained hypoglycemia detection dogs. Diabetes Res Clin Pract. 2015;109:389–96.CrossRefPubMedPubMedCentral
38.
Professional Practice Committee for the Standards of Medical Care in Diabetes-2016. Diabetes care 2016; 39 Suppl 1: S107-8.
39.
Haymond MW, Schreiner B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes Care. 2001;24:643–5.CrossRefPubMed
40.
Chung ST, Haymond MW. Minimizing morbidity of hypoglycemia in diabetes: a review of mini-dose glucagon. J Diabetes SciTechnol. 2015;9:44–51.
41.
Rickels MR, Ruedy KJ, Foster NC, Piche CA, Dulude H, Sherr JL, et al. Intranasal glucagon for treatment of insulin-induced hypoglycemia in adults with type 1 diabetes: a randomized crossover noninferiority study. Diabetes Care. 2016;39:264–70.PubMed
42.
Amiel SA, Tamborlane WV, Simonson DC, Sherwin RS. Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med. 1987;316:1376–83.CrossRefPubMed
43.
Tsalikian E, Tamborlane W, Xing D, Becker DM, Mauras N, Fiallo-Scharer R, et al. Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. Diabetes Care. 2009;32:1954–9.CrossRefPubMed
44.
Arbelaez AM, Xing D, Cryer PE, Kollman C, Beck RW, Sherr J, et al. Blunted glucagon but not epinephrine responses to hypoglycemia occurs in youth with less than 1 yr duration of type 1 diabetes mellitus. Pediatr Diabetes. 2014;15:127–34.CrossRefPubMed
45.
Ly TT, Hewitt J, Davey RJ, Lim EM, Davis EA, Jones TW. Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes. Diabetes Care. 2011;34:50–2.CrossRefPubMed
46.
Abid N, McGlone O, Cardwell C, McCallion W, Carson D. Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease. Pediatr Diabetes. 2011;12:322–5.CrossRefPubMed
47.
Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabetic Med : J Br Diabetic Assoc. 2002;19:70–3.CrossRef
48.
Bougneres P, Boileau P, Aboumrad B. Secret insulin-injection syndrome among adolescents with type 1 diabetes. N Engl J Med. 2005;353:2516–7.CrossRefPubMed
49.
Jain V, Satapathy AK, Yadav J. Surreptitious insulin overdosing in adolescents with type 1 diabetes. Indian Pediatr. 2015;52:701–3.CrossRefPubMed
Metadata
Title
Management of Hypoglycemia in Children and Adolescents with Type 1 Diabetes Mellitus
Authors
Dayna E. McGill
Lynne L. Levitsky
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 9/2016
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-016-0771-1

Other articles of this Issue 9/2016

Current Diabetes Reports 9/2016 Go to the issue

Psychosocial Aspects (S Jaser and KK Hood, Section Editors)

Physical Activity in Youth With Type 1 Diabetes: a Review

Microvascular Complications—Neuropathy (R Pop-Busui, Section Editor)

Diabetes and Cognitive Impairment

Obesity (J McCaffery, Section Editor)

Food Insecurity and Diabetes in Developed Societies

Obesity (J McCaffery, Section Editor)

Food Decision-Making: Effects of Weight Status and Age

Economics and Policy in Diabetes (ES Huang and A Baig, Section Editors)

Diabetes Prevention Interventions in Latin American Countries: a Scoping Review

Treatment of Type 1 Diabetes (M Pietropaolo, Section Editor)

A Review of Insulin-Dosing Formulas for Continuous Subcutaneous Insulin Infusion (CSII) for Adults with Type 1 Diabetes

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits