[Severe hypoglycemia and insulin antibodies levels in children and adolescents with type 1 diabetes].
Severe hypoglycemia may limit the effects of type 1 diabetes treatment. Insulin antibodies were mentioned to be included in the pathogenesis of hypoglycemia in adult diabetic patients, particularly those treated with non-human insulins. The influence of insulin antibodies on the occurrence of hypoglycemia in children treated with human insulin was not studied. THE AIM of the study was to examine insulin antibodies titers in young type 1 diabetics with a recent history of severe hypoglycemia and in matched control subjects.


METHODS
Insulin antibodies (IA) were assessed in 33 type 1 diabetic children (mean age 13.2, quartile interval 10.3-16.4) within 14 days after an episode of severe hypoglycemia. In 30 patients from this group, whose serum samples were collected also in the last two years preceding the episode of severe hypoglycemia and stored for routine immunologic assessment, IA levels before severe hypoglycemia were assessed, too. The control group consisted of 30 type 1 diabetic patients (mean age 14.4, quartile interval 12.7-15.4), who never experienced any severe hypoglycemia episode, and matched the study group for sex, age and diabetes duration. All patients were treated either with human insulin or with human insulin analogue lispro and NPH human insulin. Insulin antibodies were determined semi-quantitatively (as serum capacity to bind 125I-insulin) by radioimmunoassay.


RESULTS
Compared to controls (median value 19.5%, quartile interval 13.7-30.1%), patients who experienced severe hypoglycemia had higher IA levels after (mean value 30.6%, quartile interval 16.8-39.1%, p<0.04) as well as before hypoglycemia (mean value: 35.9, quartile interval 21.6-46.8%, p<0.02). There was a strong correlation between IA levels measured before and after severe hypoglycemia episodes (r=0.7, p<0.0001) in the study group.


CONCLUSIONS
High insulin antibodies levels may be markers of increased risk for severe hypoglycemia acting in a mechanism other than a simple imbalance between exogenous insulin, carbohydrate consumption and physical exercise.
Mianowska
Beata
B
Klinika Chorób Dzieci Instytutu Pediatrii Uniwersytetu Medycznego w Łodzi, Łódź, Poland. bjm@poczta.onet.pl
Perenc
Małgorzata
M
Heinrich
Agnieszka
A
Bodalski
Jerzy
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000276:immunology*; D007328:Insulin / Q000008:administration & dosage; D007330:Insulin Antibodies / Q000097:blood*; D008297:Male; D011446:Prospective Studies
D006442:Glycated Hemoglobin; D007328:Insulin; D007330:Insulin Antibodies