The Impact of Acute Hypoglycemia on Neuropsychological and Neurometabolite Profiles in Children With Type 1 Diabetes
- Debbie Rankins, PHD1,
- R. Mark Wellard, PHD2,
- Fergus Cameron, MD34,
- Ciara McDonnell, MD4 and
- Elisabeth Northam, PHD15
- 1Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- 2Brain Research Institute, Austin Hospital, Melbourne, Australia
- 3Centre for Hormone Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- 4Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, Australia
- 5Department of Psychology, University of Melbourne, Melbourne, Australia
- Address correspondence and reprint requests to Dr. Fergus Cameron, Department of EndocrinologyDiabetes, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, Australia 3052. E-mail: fergus.cameron{at}rch.org.au
The impact of hypoglycemia on brain is a major factor influencing the clinical management of type 1 diabetes in children. The Diabetes Control and Complications Trial (1) has shown that intensive insulin treatment is the most effective strategy for preventing the microvascular complications of type 1 diabetes, but it is associated with a threefold increase in the incidence of severe hypoglycemia. Before implementing intensified treatments in children, it is important to define the impact on the developing central nervous system associated with the increased risk of hypoglycemia. This report presents three cases of previously well children with type 1 diabetes who were studied after their first episode of severe hypoglycemia with seizure. All case subjects underwent neuropsychological assessment and neuroimaging within 48 h of the seizure and again 6 months later.
RESEARCH DESIGN AND METHODS
Case 1 was a 7-year-old girl with a 2-year history of type 1 diabetes who presented to the emergency department, Royal Children’s Hospital, following a severe hypoglycemic event with seizure. She awoke with a blood glucose level of 3.6 mmol/l. This was not treated, and she was given her usual morning dose of short- and intermediate-acting insulin. She had a seizure within 20 min of insulin administration. The seizure resolved within 5 min after treatment with glucagon and glucose gel. Her most recent HbA1c (A1C) was 7.5%.
Case 2 was a 9-year-old girl with a 6-year history of type 1 diabetes who experienced a hypoglycemic seizure immediately before breakfast after a nocturnal supplemental dose of rapid-acting insulin. She was treated with glucagon, with seizure resolution within 5 min. Her blood glucose level immediately after glucagon administration was 2.4 mmol/l. Her most recent A1C was 8.7%.
Case 3 was a 10-year-old boy with a 3-year history of type 1 diabetes who felt unwell for several days …
