Studies in hypoglycaemia in children with insulin-dependent diabetes mellitus.

Hypoglycaemia is the most important acute side effect of insulin therapy for diabetes in children. In general, children have more vigorous counterregulatory hormone responses to hypoglycaemia than adults. Children with diabetes may lose their glucagon responses to a falling blood glucose but persistence of brisk catecholamine, cortisol and growth hormone responses, coupled with the insulin resistance natural to puberty, may contribute to unstable diabetes control. Despite this, there is some evidence that younger children may not experience or at least express autonomic symptoms to the same degree as do adults. Furthermore, recurrent hypoglycaemia may induce defects in the counterregulatory responses and increase the risk of severe hypoglycaemia. Avoidance of moderate hypoglycaemia in clinical management may restore normal warning. There is research evidence to suggest that the human brain may be able to use non-glucose fuels to support its metabolism and function during hypoglycaemia but this is not yet translatable into clinical practice and care to avoid hypoglycaemia in daily life remains the patients' best protection.