The Awareness of Hypoglycaemia in Children and Adolescents with Type 1 Diabetes Mellitus

There is a wide variation in the awareness of hypoglycaemia in children and adolescents with type 1 diabetes mellitus. It was the goal of the trial to assess in a systematic way symptoms, blood glucose values and the awareness of hypoglycaemia in patients and their parents. Methods: Eighty-four children and adolescents with type 1 diabetes mellitus and their parents were included in the trial, successively admitted to the MEDIGREIF-Inselklinik Heringsdorf, Heringsdorf, Germany, between May and September 2008 (age 13.1 +/- 3.4 years, diabetes duration 5.1 +/- 3.9 years, HbA1c [DCA2000 (R), Bayer Diagnostics, normal range 4.5-5.7%] 9.1 +/- 2.1 %). Awareness of hypoglycaemia was assessed using standardised questionnaires (including the assessment of symptoms, blood glucose values in the case of hypoglycaemia and psychological parameters). Moreover all children and adolescents were asked to paint their awareness of and impressions during hypoglycaemia. Results: In the mean children and adolescents reported to register symptoms of hypoglycaemia at blood glucose values of 3.63 +/- 0.83 mmol/l. In 37% (31/84) first symptoms occurred at or below 2.5 mmol/l. In 56% of patients hypoglycaemic episodes were registered at different times during day and night. In 18% of the patients predominantly hypoglycaemia occurred at midday, in 14% in the morning, in 14% in the evening, and in 12% during the night. Most frequently patients reported the following symptoms: Shiver (88%), hunger (60%), unable to concentrate (52%), perspiration (49%), tiredness (46%) and agitation (35%), aggressivity (33%). In contrast, the parents felt different symptoms: 28% reported paleness, 21% cognitive impairment, 14% aggressivity, 8% agitation and only 6% shiver, 3% perspiration and 3% problems with speaking. Most frequently hypoglycaemia were the result of physical activity. In 10% of the patients hypoglycaemic episodes occurred during stress, in 7% during sleeping and in 7% during playing. 41% of the children and adolescents reported sometimes suffering from hypoglycaemia during daily activities, 19% often and 6% always. A correlation analysis revealed no association between the fear of hypoglycaemia and HbA1c (r=0.125, p=0.343). Painting pictures the children and adolescents demonstrated very negative and bad impressions during hypoglycaemia. Conclusions: In a high percentage of children and adolescents with type 1 diabetes mellitus hypoglycaemia occurred at relatively low blood glucose values. Patients and parents registered different symptoms. Many children and adolescents are in a high fear of hypoglycaemia. However, there were no associations between the fear of hypoglycaemia and the quality of diabetes control. Hypoglycaemia, their awareness and training in prevention should be important parts of structured patient education.