Feature Article

Hypoglycemia in children and adolescents

Trang Ly MBBS DCH, Tim Jones MD, DCH, FRACP

Diabetic Hypoglycemia September 2009, Volume 2, Issue 2: page 3-10

Abstract

Hypoglycemia is a significant problem for children and adolescents with type 1 diabetes, impairing quality of life and affecting concentration, learning and physical activity. Despite modern therapy, hypoglycemia remains a critical concern in young patients, particularly those who are too young to manage their own blood glucose levels.

There can be significant developmental and age-related differences in glycemic control in children and adolescents to those in adults. This review discusses the physiologic and behavioral mechanisms underlying these differences, highlighting that there may be a greater susceptibility to hypoglycemia in the young. The authors point out that, as nearly all glucose response studies have been conducted in adolescents, less is known about responses in pre-adolescents. The review also covers symptoms of hypoglycemia in childhood, hypoglycemia incidence, nocturnal hypoglycemia, clinical precipitants, impaired awareness of hypoglycemia, and treatment guidelines.

In addition, the authors discuss the susceptibility of the brain to the adverse effects of severe hypoglycemia, and the association between hypoglycemia and decreased neurocognitive functioning in children with type 1 diabetes, concluding that there is evidence to suggest that long-term consequences of hypoglycemia on the CNS are more likely in the very young child. They also conclude that the severity and frequency of hypoglycemia in young patients may be reduced by understanding the risk factors for hypoglycemia, regular glucose monitoring, and individually tailored insulin regimens.

Keywords: hypoglycemia, children, adolescents, cognitive function