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The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive insulin treatment could lead to severe hypoglycemia in adults with type 1 diabetes. The study, however, did not address the effects of intensive insulin treatments and their effects on type 1 children. While it has been documented that severe hypoglycemia causes neurological damage in adult type 1 patients, there has been no conclusive evidence of what it does to children.
According to the September 1998 issue of Diabetes Care, children with type 1 diabetes were recently tested to determine the effects of intensive insulin treatment on neurological function.
The tests were conducted by Luisa Spallino, MD, and a team of researchers at Sant' Anna Hospital in Como, Italy. Nine episodes of acute hemiparesis (slight paralysis affecting one side of the body) were observed in five children who had suffered hemiparesis following nocturnal hypoglycemia. When contacted in Italy, Dr. Spallino said that all five of the children had been diagnosed with type 1 diabetes at an early age, and were receiving a combination of short and intermediate-acting human insulin given before breakfast and evening meals at the dosage of 0.7-1 U/Kg/day.
Three of the five children reported having hemiparesis. In all five children, the spontaneous hypoglycemic episode occurred in the early hours of the morning, and blood glucose levels ranged between 1.9 and 3.0 mg/dl. All of the children experienced confusion and weakness on one side of their bodies; two of the children experienced speech impediments and one child suffered a paralysis of muscle function. All five children were right handed, and four of them suffered the hemiparesis on their left sides. The researchers took this to mean that the "nondominant hemisphere" was more susceptible to hypoglycemia.
Spallino reports that the timing of the children's recovery may be related to the length of the hypoglycemic episode. Furthermore, no immediate signs of neurological dysfunction were evident, and no cognitive impairment could be noted.
Although the effects of hemiparesis on cognitive function and neurological development have not yet been studied, Spallino suggests that damage would most commonly occur in the neurons of the middle layer of the cerebral cortex. Spallino speculates that the brain stem and spinal cord would be more resistant to damage. Previous studies have shown that there is an increase in blood flow to the brain during episodes of hypoglycemia.
In conclusion, Spallino and her research team suggest that children diagnosed with type 1 diabetes before the age of 5 are at risk of hemiparesis associated with episodes of hypoglycemia. In addition, children receiving more than one injection of insulin per day may be more susceptible and experience greater frequency and susceptibility to hypoglycemia. Although the long-term consequences remain unknown, it is suggested that tight blood glucose control could actually be the primary factor in causing such problems.
0 comments - Dec 1, 1998
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