Experience of severe hypoglycaemia may influence both patient's and physician's subsequent treatment policy of insulin-dependent diabetes mellitus

Daily insulin doses and HbA1c were studied 0-3 months before and 2-6, 7-11, and 12-16 months after 48 consecutive episodes of severe hypoglycaemia (coma and/or convulsion) in children and adolescents with insulin-dependent diabetes mellitus. After 69% of the attacks, either physicians or patients or...

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Bibliographic Details
Published in:European journal of pediatrics 1998-08, Vol.157 (8), p.625-627
Main Authors: TUPOLA, S, RAJANTIE, J, AKERBLOM, H. K
Format: Article
Language:English
Subjects:
Adolescent
Attitude of Health Personnel
Biological and medical sciences
Blood Glucose - metabolism
Child
Coma
Diabetes
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - drug therapy
Dose-Response Relationship, Drug
Drug Administration Schedule
Families & family life
Female
Glycated Hemoglobin A - metabolism
Hormones. Endocrine system
Humans
Hypoglycemia
Insulin
Insulin - administration & dosage
Insulin - adverse effects
Insulin Coma - blood
Insulin Coma - prevention & control
Male
Medical sciences
Patient Education as Topic
Patients
Pharmacology. Drug treatments
Physicians
Puberty
Teenagers
Treatment Refusal
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Summary:Daily insulin doses and HbA1c were studied 0-3 months before and 2-6, 7-11, and 12-16 months after 48 consecutive episodes of severe hypoglycaemia (coma and/or convulsion) in children and adolescents with insulin-dependent diabetes mellitus. After 69% of the attacks, either physicians or patients or both decreased daily insulin doses (for the whole group, mean SD: 0-3 months before the episode 0.93 0.20 U/kg vs 2-6 months after 0.84 0.20 U/kg, P < 0.001), which may have worsened the subsequent glycaemic control as evidenced by a significant increase in HbA1c (8.3+/-1.5% vs 9.1+/-1.8%, P< 0.001, respectively). Physicians decreased the insulin dose even in 14 of the 33 patients with a preventable cause for their hypoglycaemia other than erroneous excess of insulin. Experience of severe hypoglycaemia may worsen the subsequent glycaemic control. This might in part be due to an excessive lowering of daily insulin doses by both physicians as well as patients and their families. Hypoglycaemia management must include intensive education about prevention without compromising diabetes control.
ISSN:0340-6199
1432-1076
DOI:10.1007/s004310050899