Iatrogenic hypoglycemia causes recurrent morbidity in most people with type 1 diabetes and many with type 2 diabetes, and it is sometimes fatal. The barrier of hypoglycemia generally precludes maintenance of euglycemia over a lifetime of diabetes and thus precludes full realization of euglycemia’s long-term benefits. While the clinical presentation is often characteristic, particularly for the experienced individual with diabetes, the neurogenic and neuroglycopenic symptoms of hypoglycemia are nonspecific and relatively insensitive; therefore, many episodes are not recognized. Hypoglycemia can result from exogenous or endogenous insulin excess alone. However, iatrogenic hypoglycemia is typically the result of the interplay of absolute or relative insulin excess and compromised glucose counterregulation in type 1 and advanced type 2 diabetes. Decrements in insulin, increments in glucagon, and, absent the latter, increments in epinephrine stand high in the hierarchy of redundant glucose counterregulatory factors that normally prevent or rapidly correct hypoglycemia. In insulin-deficient diabetes (exogenous) insulin levels do not decrease as glucose levels fall, and the combination of deficient glucagon and epinephrine responses causes defective glucose counterregulation. Reduced sympathoadrenal responses cause hypoglycemia unawareness. The concept of hypoglycemia-associated autonomic failure in diabetes posits that recent antecedent hypoglycemia causes both defective glucose counterregulation and hypoglycemia unawareness. By shifting glycemic thresholds for the sympathoadrenal (including epinephrine) and the resulting neurogenic responses to lower plasma glucose concentrations, antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation. Thus, short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in most affected patients. The clinical approach to minimizing hypoglycemia while improving glycemic control includes 1 ) addressing the issue, 2 ) applying the principles of aggressive glycemic therapy, including flexible and individualized drug regimens, and 3 ) considering the risk factors for iatrogenic hypoglycemia. The latter include factors that result in absolute or relative insulin excess: drug dose, timing, and type; patterns of food ingestion and exercise; interactions with alcohol and other drugs; and altered sensitivity to or clearance of insulin. They also include factors that are clinical surrogates of compromised glucose counterregulation: endogenous insulin deficiency; history of severe hypoglycemia, hypoglycemia unawareness, or both; and aggressive glycemic therapy per se, as evidenced by lower HbA 1c levels, lower glycemic goals, or both. In a patient with hypoglycemia unawareness (which implies recurrent hypoglycemia) a 2- to 3-week period of scrupulous avoidance of hypoglycemia is advisable. Pending the prevention and cure of diabetes or the development of methods that provide glucose-regulated insulin replacement or secretion, we need to learn to replace insulin in a much more physiological fashion, to prevent, correct, or compensate for compromised glucose counterregulation, or both if we are to achieve near-euglycemia safely in most people with diabetes.

https://care.diabetesjournals.org/content/diacare/26/6/1902.full.pdf

Hypoglycemia in Diabetes

It is now 20 years since Dr Tomisaku Kawasaki first reported a series of Japanese children with an illness he called 'acute febrile mucocutaneous lymph node syndrome',' but which is now more commonly referred to as Kawasaki disease.2 The disorder has since been recognised to be an important and relatively common childhood illness, occurring worldwide; and with a greatly increased prevalence in Japan.3 4 The association of Kawasaki disease with coronary artery aneurysms, coronary thrombosis, and myocardial infarction5 has made the disorder an unusually worrying one and has led to considerable efforts to establish its cause. In the past few years there have been exciting advances in the understanding of the epidemiology, pathogenesis, clinical spectrum, and treatment of Kawasaki disease. The purpose of this article is to review briefly some of these important advances, which are of relevance to paediatricians in this country.

/pdf/archives-of-disease-in-childhood-1nzy0657nx.pdf

Archives of disease in childhood

Kenneth Robertsona, Michael C Riddellb, Benjamin C Guinhouyac, Peter Adolfssond,e and Ragnar Hanase,f aGreater Glasgow & Clyde Children’s Diabetes Service, Royal Hospital for Sick Children, Glasgow, UK; bSchool of Kinesiology and Health Science, York University, Toronto, Canada; cEA 2694, Laboratory of Public Health, Faculty for Health engineering and management, USDL, University Lille Northern France, Lille, France; dDepartment of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden; eInstitute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Swedenand fDepartment of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, Sweden

ISPAD Clinical Practice Consensus Guidelines 2014. Exercise in children and adolescents with diabetes.

In the field of technology, intermittent scanning continuous glucose monitoring (isCGM) offers the opportunity to obtain glucose values more easily than with self-monitored blood glucose monitoring (SMBG). This technology also provides the user with information on the direction and the rate of glucose value changes. However, the individual must actively scan the sensor to receive a value. Alerts or alarms are not currently linked to this technology. This article is protected by copyright. All rights reserved.

ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes.

University ofSydney, The Children’s Hospital at Westmead, NSW, Australia.Corresponding author:Jennifer CouperMcGregor Reid Professor, Head Discipline of Paediatrics,University of Adelaide, Head Endocrinology and Diabetes,Womens and Childrens Hospital, SA.Tel: +61 8 8161 6242e-mail: jennifer.couper@adelaide.edu.auAcknowledgments: Denis Daneman, Desmond SchatzConﬂicts of interest: The authors have declared no conﬂictsof interest.Editors of the ISPAD Clinical Practice Consensus Guide-lines 2009 Compendium; Kim Donaghue, Ragnar Hanas,Georgeanna Klingensmith, Peter GF Swift.This article is a chapter in the

ISPAD Clinical Practice Consensus Guidelines 2009 Compendium

Blood glucose measurements were made at 2200, 0200, and 0800 h in 102 children with diabetes during a 24 hour planned admission to hospital. Nocturnal hypoglycaemia (less than 3.0 mmol/l) occurred in 24 of 71 (34%) children on twice daily insulin and in three of 31 (10%) children on once daily insulin. Predictive value modelling showed that a blood glucose concentration of less than 7 mmol/l at 2200 h was the best predictor of nocturnal hypoglycaemia, with a sensitivity of 63%, specificity of 94%, and positive and negative predictive values of 83%. Blood glucose measurement at 0800 h had no predictive value for nocturnal hypoglycaemia. The mean (SD) glycosylated haemoglobin concentration of children on twice daily insulin who had nocturnal hypoglycaemia was 55 (8) mmol HMF/mol Hb, which was significantly less than that of children on twice daily insulin who did not have hypoglycaemia (64 (11) mmol HMF/mol Hb) or those on once daily insulin (62 (11) mmol HMF/mol Hb). A controlled trial was then performed in which 29 children with diabetes who had a blood glucose concentration at 2200 h of less than 7 mmol/l measured by Reflocheck were randomised into two groups, one of which received 10 g carbohydrate supplement and the other of which did not. Thirteen of the 14 children in the control group had hypoglycaemia at 0200 h, whereas the snack prevented hypoglycaemia in 12 of 15 in the test group. Blood glucose values in the two groups at 0800 h were similar. We conclude that bedtime glucose measurement in children on twice daily insulin is a useful predictor for nocturnal hypoglycaemia, which can be prevented by a small carbohydrate snack in those at risk.

https://adc.bmj.com/content/archdischild/62/4/333.full.pdf

Prediction and management of nocturnal hypoglycaemia in diabetes.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

R D Milner

Author Tools

Chat about Author

Papers

Prediction and management of nocturnal hypoglycaemia in diabetes.