Hypoglycemia Responses Change Through Puberty

Responses to hypoglycemia may change as children progress through puberty, the study also found, and children in the middle stages of puberty seem to be most sensitive to hypoglycemia.

Researchers from the Royal Infirmary of Edinburgh in Scotland compared physiological and autonomic responses to acute hypoglycemia induced by insulin infusion in 27 type 1 diabetic children in pre-pubertal (n = 8), mid-pubertal (n = 7) and post-pubertal (n = 12) stages of development.

At the onset of hypoglycemic autonomic reaction, blood glucose concentrations were lower in pre-pubertal than mid-pubertal children (2.0 vs 2.5 mmol/L) and correlated positively with HbA1c values, Dr. Brian M. Frier and colleagues report in the February Archives of Diseases of Childhood.

In all children, regardless of pubertal stage, hypoglycemia produced only minimal increases in concentrations of the counterregulatory hormone glucagon. "As in adults, the glucagon response to hypoglycemia was deficient within a few years of developing diabetes," the authors point out.

None of the children mounted a significant nonadrenaline response to hypoglycemia, which the authors say was unexpected.
The pancreatic polypeptide response, an established marker of autonomic activation in adults, was absent in pre-pubertal children, but appeared to be fully developed in post-pubertal children. Mid-pubertal children displayed a small nonsignificant increase in the pancreatic polypeptide response.

In contrast with diabetic adults, diabetic children rarely generated a sweating response to hypoglycemia. Only 2 of 27 had this reaction and both were post-pubertal.

Taken together, these findings suggest "qualitative differences" in some responses to hypoglycemia between children and adults, the authors note. The findings also suggest that some responses to acute hypoglycemia are apt to change as diabetic children progress through puberty.
Arch Dis Child 2005;90:190-194.

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