Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes

Eva Tsalikian, William Tamborlane, Dongyuan Xing, Dorothy M. Becker, Nelly Mauras, Rosanna Fiallo-Scharer, Bruce Buckingham, Stuart Weinzimer, Michael Steffes, Ravinder Singh, Roy Beck, Katrina Ruedy, Craig Kollman

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE - Hypoglycemia in young children with type 1 diabetes 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 sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures. RESEARCH DESIGNANDMETHODS - 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 counterregulatory hormone concentrations were measured in 14 young children (3 to <8 years, A1C 7.7 ± 0.6%) vs. 14 adolescents (12 to <18 years, A1C 7.6 ± 0.8%). RESULTS - Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five 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 with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher. CONCLUSIONS - These data suggest that even young children and adolescents with type 1 diabetes 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.

Original languageEnglish (US)
Pages (from-to)1954-1959
Number of pages6
JournalDiabetes care
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2009

Fingerprint

Type 1 Diabetes Mellitus
Hypoglycemia
Hormones
Glucose
Insulin
Epinephrine
Subcutaneous Infusions
Hypoglycemic Agents
Signs and Symptoms
Inpatients
Parents
Therapeutics

Cite this

Tsalikian, E., Tamborlane, W., Xing, D., Becker, D. M., Mauras, N., Fiallo-Scharer, R., ... Kollman, C. (2009). Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. Diabetes care, 32(11), 1954-1959. https://doi.org/10.2337/dc08-2298

Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. / Tsalikian, Eva; Tamborlane, William; Xing, Dongyuan; Becker, Dorothy M.; Mauras, Nelly; Fiallo-Scharer, Rosanna; Buckingham, Bruce; Weinzimer, Stuart; Steffes, Michael; Singh, Ravinder; Beck, Roy; Ruedy, Katrina; Kollman, Craig.

In: Diabetes care, Vol. 32, No. 11, 01.11.2009, p. 1954-1959.

Research output: Contribution to journalArticle

Tsalikian, E, Tamborlane, W, Xing, D, Becker, DM, Mauras, N, Fiallo-Scharer, R, Buckingham, B, Weinzimer, S, Steffes, M, Singh, R, Beck, R, Ruedy, K & Kollman, C 2009, 'Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes', Diabetes care, vol. 32, no. 11, pp. 1954-1959. https://doi.org/10.2337/dc08-2298
Tsalikian, Eva ; Tamborlane, William ; Xing, Dongyuan ; Becker, Dorothy M. ; Mauras, Nelly ; Fiallo-Scharer, Rosanna ; Buckingham, Bruce ; Weinzimer, Stuart ; Steffes, Michael ; Singh, Ravinder ; Beck, Roy ; Ruedy, Katrina ; Kollman, Craig. / Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. In: Diabetes care. 2009 ; Vol. 32, No. 11. pp. 1954-1959.
@article{bca94cf9aeaf43b689557a4de9643c75,
title = "Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes",
abstract = "OBJECTIVE - Hypoglycemia in young children with type 1 diabetes 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 sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures. RESEARCH DESIGNANDMETHODS - 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 counterregulatory hormone concentrations were measured in 14 young children (3 to <8 years, A1C 7.7 ± 0.6{\%}) vs. 14 adolescents (12 to <18 years, A1C 7.6 ± 0.8{\%}). RESULTS - Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five 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 with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher. CONCLUSIONS - These data suggest that even young children and adolescents with type 1 diabetes 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.",
author = "Eva Tsalikian and William Tamborlane and Dongyuan Xing and Becker, {Dorothy M.} and Nelly Mauras and Rosanna Fiallo-Scharer and Bruce Buckingham and Stuart Weinzimer and Michael Steffes and Ravinder Singh and Roy Beck and Katrina Ruedy and Craig Kollman",
year = "2009",
month = "11",
day = "1",
doi = "10.2337/dc08-2298",
language = "English (US)",
volume = "32",
pages = "1954--1959",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "11",

}

TY - JOUR

T1 - Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes

AU - Tsalikian, Eva

AU - Tamborlane, William

AU - Xing, Dongyuan

AU - Becker, Dorothy M.

AU - Mauras, Nelly

AU - Fiallo-Scharer, Rosanna

AU - Buckingham, Bruce

AU - Weinzimer, Stuart

AU - Steffes, Michael

AU - Singh, Ravinder

AU - Beck, Roy

AU - Ruedy, Katrina

AU - Kollman, Craig

PY - 2009/11/1

Y1 - 2009/11/1

N2 - OBJECTIVE - Hypoglycemia in young children with type 1 diabetes 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 sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures. RESEARCH DESIGNANDMETHODS - 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 counterregulatory hormone concentrations were measured in 14 young children (3 to <8 years, A1C 7.7 ± 0.6%) vs. 14 adolescents (12 to <18 years, A1C 7.6 ± 0.8%). RESULTS - Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five 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 with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher. CONCLUSIONS - These data suggest that even young children and adolescents with type 1 diabetes 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.

AB - OBJECTIVE - Hypoglycemia in young children with type 1 diabetes 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 sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures. RESEARCH DESIGNANDMETHODS - 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 counterregulatory hormone concentrations were measured in 14 young children (3 to <8 years, A1C 7.7 ± 0.6%) vs. 14 adolescents (12 to <18 years, A1C 7.6 ± 0.8%). RESULTS - Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five 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 with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher. CONCLUSIONS - These data suggest that even young children and adolescents with type 1 diabetes 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.

UR - http://www.scopus.com/inward/record.url?scp=70449426856&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70449426856&partnerID=8YFLogxK

U2 - 10.2337/dc08-2298

DO - 10.2337/dc08-2298

M3 - Article

VL - 32

SP - 1954

EP - 1959

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 11

ER -