[Impact of hypoglycemic episodes on nerves conduction and auditory and visual evoked potentials in children with type 1 diabetes].
BACKGROUND
Hypoglycemia is an acute disturbance of energy, especially impacting the central nervous system, but direct influence on peripheral nervous function is not detected. The aim of the study was to establish the influence of hypoglycemic moderate and severe episodes on the function of peripheral nerves, hearing and visual pathway.


METHODS
97 children with type 1 diabetes (mean age 15.4+/-2.16 years, mean duration of diabetes 8.11+/-2.9 years, mean HbA1c 8,58+/-1.06%), at least 10 years old and with at least 3 years duration of diabetes, were included to study. Nerve conduction studies, visual (VEP) and auditory (ABR) evoked potentials were performed with standard surface stimulating and recording techniques. Moderate hypoglycemic episodes were defined as events of low glycemia requiring help of another person but without loss of consciousness and/or convulsions but recurrent frequently in at least one year. Severe hypoglycemia was defined as events with loss of consciousness and/or convulsions. Univariate ANOVA tests of significance or H Kruskal-Wallis test were used, depending on normality of distribution.


RESULTS
The subgroups with a history of hypoglycemic episodes had significant delay in all conduction parameters in the sural nerve (amplitude p<0.05, sensory latency p<0.05, and velocity p<0.005) and in motor potential amplitude of tibial nerve (p<0.005). In ABR wave III latency and interval I-III in subgroups with episodes of hypoglycemia (p<0,05) were significantly prolonged. In analyses of VEP parameters no differences were detected.


CONCLUSIONS
The study showed influence of hypoglycemic episodes on function of all sural nerve parameters and tibial motor amplitude, and in ABR on wave III and interval I-III. Frequent moderate hypoglycemic episodes were strong risk factors for damage of the peripheral and central nervous systems, comparable with impact of several severe hypoglycemias.
Wysocka-Mincewicz
Marta
M
Klinika Pediatrii Centrum Zdrowia Dziecka w Warszawie. marta.wysocka@film-tv.pl
Trippenbach-Dulska
Hanna
H
Emeryk-Szajewska
Barbara
B
Zakrzewska-Pniewska
Beata
B
Kochanek
Krzysztof
K
Pańkowska
Ewa
E
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000209:etiology / Q000503:physiopathology*; D005072:Evoked Potentials, Auditory; D005074:Evoked Potentials, Visual; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008991:Monitoring, Physiologic; D009431:Neural Conduction; D010543:Peroneal Nerve / Q000503:physiopathology; D012016:Reference Values; D013497:Sural Nerve / Q000503:physiopathology; D013979:Tibial Nerve / Q000503:physiopathology
D006442:Glycated Hemoglobin