Blunted Counter-regulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents with Well-controlled Type 1 Diabetes

  1. Diabetes Research in Children Network (DirecNet) Study Group (direcnet{at}


    Objectives: Hypoglycemia in young children with T1DM is an acute complication of intensive insulin therapy and is commonly observed in the absence of signs or symptoms. The effect of intensive treatment and patient age on sympatho-adrenal responses has not been established in youth with T1DM due to difficulties in testing procedures.

    Methods: We developed a standardized inpatient continuous subcutaneous insulin infusion protocol to produce a progressive fall in plasma glucose concentrations in insulin pump-treated patients. Plasma glucose and counter-regulatory hormone concentrations were measured in 14 young children (3 to <8 years, HbA1c 7.7 ± 0.6%) vs. 14 adolescents (12 to <18 years, HbA1c 7.6 ± 0.8%).

    Results: Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and 4 adolescents never had an epinephrine response. In the 4 young children and 5 adolescents who had a modest epinephrine response, this only occurred when plasma glucose fell to <60 mg/dL. In evaluating symptom scores, 29% of parents of young children felt that their child looked hypoglycemic even at the lowest plasma glucose concentrations. Adolescents were better able to detect symptoms of hypoglycemia. In comparison to our data, epinephrine response to hypoglycemia in 14 non-diabetic adolescents studied at the Children's Hospital of Pittsburgh was higher.

    Conclusions: These data suggest that even young children and adolescents with T1DM are prone to develop hypoglycemia-associated autonomic failure regardless of duration. Whether these abnormalities can be reversed using continuous glucose monitoring and closed loop insulin delivery systems awaits further study.


      • Received December 3, 2008.
      • Accepted July 23, 2009.

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    1. Diabetes Care
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