title: Counterregulatory hormone and symptom responses to hypoglycaemia in diabetic children.
abstract: The hormonal responses to, and symptoms of, hypoglycaemia were investigated in 19 diabetic children (mean age 14.2 (SD 1.4) years, mean HbA1c 9.8 (SD 1.2)%) and 16 non-diabetic children (14.4(1.0) years) during a gradual reduction in plasma glucose with the glucose clamp technique. Plasma glucose was reduced from approximately 5.7 to approximately 2.6 mmol l(-1) in the diabetic children and from approximately 5.7 to approximately 2.9 mmol l(-1) in the non-diabetic children over 200 min. The mean glycaemic thresholds for adrenaline, and for autonomic and total symptom score, were similar in the diabetic and non-diabetic groups, and were found at plasma glucose levels between 3.4 and 3.7 mmol l(-1). The mean glucose levels which elicited increase of cortisol, growth hormone, and glucagon were lower (p < 0.01), and the mean incremental responses of adrenaline, cortisol, and glucagon were smaller in the diabetic than in the non-diabetic children. In the diabetic children, a correlation was found between Body Mass Index (BMI) and the hypoglycaemic thresholds for autonomic and total symptom scores (r = 0.64, p < 0.01 and r = 0.72, p = 0.001, respectively). We conclude that counterregulatory hormone responses are attenuated in diabetic as compared to non-diabetic children, whereas recognition of autonomic symptoms is similar in the two groups. Diabetic children with a higher BMI seem to have increased awareness of a declining plasma glucose level.
authors.affiliation: Department of Clinical Chemistry, University Hospital of Trondheim, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Bjørgaas
authors.forename: T
authors.initials: T
authors.lastname: Vik
authors.forename: T
authors.initials: T
authors.lastname: Sand
authors.forename: K
authors.initials: K
authors.lastname: Birkeland
authors.forename: G
authors.initials: G
authors.lastname: Sager
authors.forename: H
authors.initials: H
authors.lastname: Vea
authors.forename: R
authors.initials: R
authors.lastname: Jorde
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000378:metabolism; D002648:Child; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000503:physiopathology*; D004837:Epinephrine / Q000378:metabolism; D005260:Female; D005934:Glucagon / Q000378:metabolism; D005947:Glucose / Q000494:pharmacology; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000378:metabolism; D013006:Growth Hormone / Q000378:metabolism; D006728:Hormones / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007003:Hypoglycemia / Q000378:metabolism* / Q000503:physiopathology*; D007328:Insulin / Q000378:metabolism / Q000494:pharmacology; D008297:Male; D009638:Norepinephrine / Q000378:metabolism; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D004837:Epinephrine; D005934:Glucagon; D005947:Glucose; D006442:Glycated Hemoglobin; D013006:Growth Hormone; D006728:Hormones; D006854:Hydrocortisone; D007328:Insulin; D009638:Norepinephrine