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Hypoglycemia
Definition
There is no consistent or agreed definition of hypoglycemia for the diabetic child
- In theory, hypoglycemia is the level of BG at which physiological neurological dysfunction begins
- In practice, neurological dysfunction can be symptomatic or asymptomatic, and the level at which it occurs
- varies between individuals
- may vary with time and circumstances
- is affected by antecedent hypoglycemia
Clinically, hypoglycemia causes signs and symptoms of
Autonomic activation (hunger, trembling of hands or legs, palpitations, anxiety, pallor, sweating)
- BG threshold for autonomic (counter-regulatory) activation
- experimentally has been shown to be at a higher BG level in children than adults
- varies with level of metabolic control
poor control — threshold for autonomic activation is at a higher BG level
good control — threshold for autonomic activation is at a lower BG level
- may be lowered by antecedent hypoglycemia
- is lowered by sleep
Neuroglycopenia (impaired thinking, change of mood, irritability, dizziness, headache, tiredness, confusion and later convulsions and coma)
- BG threshold for cognitive impairment is usually between 2.6 and 3.5 mmol/l (plasma glucose 3.1–4.0 mmol/l)
Neuroglycopenia may occur before autonomic activation (causing hypoglycemic unawareness)
Recommendation
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The level of BG should be maintained above 4 mmol/l
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