[How often does decreased consciousness of hypoglycaemia occur in children and adolescents with diabetes type 1 and what are its consequences?].

Jadwiga Peczyńska, Mirosława Urban, Barbara Głowińska, Bozena Florys
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Abstract

Unlabelled: The inability of the patient to recognize the risk of hypoglycemia is a very frequent phenomenon, but it is also often an underestimated complication in diabetes treated with insulin. The results of DCCT trial revealed that intensification in insulin therapy increases three-fold the risk of severe hypoglycaemia. Feeling the state of hypoglycaemia is the basic defensive mechanism in patients with diabetes type 1, making possible to start the self treatment. The decreased consciousness of hypoglycaemia makes limitations to intensive insulin therapy, which main aim is to stop later complications. THE AIM OF THE STUDY was to answer the questions: 1. How often does lack of consciousness of hypoglycaemia occur in children and adolescents with diabetes type 1. 2. What are the possible factors influencing appearance of hypoglycaemia. 3. Is lack of hypoglycaemia consciousness of a risk factor for severe hypoglycaemia.

Material and methods: The study was carried out on 318 patients aged x=13.6 yrs (4-21), suffering from diabetes, mean 6.6 yrs (2-18). The study was retrospective taking into consideration the period from 1.01.1998 to 31.12.2002.

Results: In the analysis of the questionnaire assessing the occurrence of hypoglycaemia it was found that 82 patients (25.8%) have problems with feeling the state of hypoglycaemia. We analyzed the influence of time of lasting diabetes and we found that patients with a longer duration of the disease more frequently have problems with feeling hypoglycaemia, 57% patients with lack of hypoglycaemia consciousness have bad metabolic control of the disease. In the analyzed period, 64 incidences of severe hypoglycaemia in 48 patients (30 boys and 18 girls) were found. In patients with lack of consciousness of feeling hypoglycaemia the incidences of severe hypoglycaemia occurred ten times more frequently compared to patients who feel hypoglycaemia. Sleeping makes it impossible to perceive early symptoms of hypoglycaemia: in our patients 51 severe incidences (79.7%) occurred at 1.00-3.00 a.m., 6 (9.3%) occurred at daybreak and 7 (11%) in the evening.

Conclusions: 1. In patients with diabetes type 1 the lack of hypoglycaemia consciousness occurs in about 25%. 2. The lack of hypoglycaemia consciousness is closely connected with time of diabetes duration and with recurrence of hypoglycaemia incidences. 3. Patients with lack of hypoglycaemia consciousness are at greater risk for severe hypoglycemia.

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[儿童和青少年1型糖尿病患者低血糖意识下降的频率及其后果是什么?]
未标记:患者无法识别低血糖的风险是一个非常常见的现象,但在胰岛素治疗的糖尿病中,这也是一个经常被低估的并发症。DCCT试验结果显示,胰岛素强化治疗使严重低血糖的风险增加三倍。感知低血糖状态是1型糖尿病患者的基本防御机制,使自我治疗成为可能。低血糖意识的降低限制了胰岛素强化治疗,其主要目的是阻止后期并发症。本研究的目的是回答以下问题:1。儿童和青少年1型糖尿病患者缺乏低血糖意识的频率是多少?2. 影响低血糖症状的可能因素有哪些?3.缺乏低血糖意识是发生严重低血糖的危险因素之一。材料与方法:研究对象为318例糖尿病患者,年龄x=13.6岁(4-21岁),平均6.6岁(2-18岁)。该研究是回顾性的,研究时间为1998年1月1日至2002年12月31日。结果:对低血糖发生情况问卷进行分析,发现有82例(25.8%)患者存在低血糖状态感觉问题。我们分析了糖尿病持续时间的影响,发现病程越长患者出现感觉低血糖问题的频率越高,57%低血糖意识缺乏的患者对疾病的代谢控制较差。在分析期间,48例(男30例,女18例)发生64例严重低血糖。无低血糖意识的患者发生严重低血糖的频率是有低血糖意识的患者的10倍。睡眠使得无法察觉低血糖的早期症状:在我们的患者中,51例(79.7%)发生在凌晨1 -3点,6例(9.3%)发生在黎明,7例(11%)发生在晚上。结论:1。在1型糖尿病患者中,大约25%的人缺乏低血糖意识。2. 低血糖意识的缺乏与糖尿病病程时间和低血糖发病率的复发密切相关。3.低血糖意识缺乏的患者发生严重低血糖的风险较大。
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