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Archives of Disease in Childhood 2005;90:190-194
© 2005 BMJ Publishing Group & Royal College of Paediatrics and Child Health

ORIGINAL ARTICLE

Pubertal stage and hypoglycaemia counterregulation in type 1 diabetes

L A Ross1, R E Warren2, C J H Kelnar1, B M Frier2

1 Section of Child Life and Health, Department of Reproductive and Developmental Sciences, University of Edinburgh, Scotland, UK
2 Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK

Correspondence to:
Correspondence to:
Professor B M Frier
Department of Diabetes, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK; brian.frier{at}luht.scot.nhs.uk

Aims: To compare physiological and autonomic responses to acute hypoglycaemia in diabetic children in pre-, mid-, and post-pubertal stages of development.

Methods: Twenty seven children (8 pre-pubertal, 7 mid-pubertal, 12 post-pubertal) with type 1 diabetes were studied. Hypoglycaemia was induced by insulin infusion until an autonomic reaction (R) was identified. Counterregulatory hormone levels were measured at baseline, R, R+15, and R+30 minutes. Haemodynamic changes and sweat production were measured.

Results: The mean blood glucose level at R was lower in pre-pubertal than mid-pubertal children (2.0 v 2.5 mmol/l), and was positively correlated with HbA1c. Glucagon and noradrenaline responses to hypoglycaemia were minimal in all children. A brisk increase in pancreatic polypeptide (PP) concentration only occurred in post-pubertal children. Only two children showed a sweating response to hypoglycaemia.

Conclusions: The blood glucose level at which sympatho-adrenal responses to hypoglycaemia were activated was associated with glycaemic control, and varied with pubertal stage. As in adults, the glucagon response to hypoglycaemia was deficient within a few years of developing diabetes. However, sweating and secretion of PP in response to hypoglycaemia did not occur until after puberty, indicating some qualitative differences from adults.

Abbreviations: ANOVA, analysis of variance; BMI, body mass index; CV, coefficient of variation; FSH, follicle stimulating hormone; HbA1c, glycated haemoglobin; IRMA, immunoradiometric assay; LH, luteinising hormone; PP, pancreatic polypeptide; T1DM, type 1 diabetes mellitus

Keywords: type 1 diabetes; puberty; insulin; hypoglycaemia; counterregulation


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Arch. Dis. Child. 2005 90: 111a. [Extract] [Full Text] [PDF]





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