Twice-daily insulin not ideal for diabetic kids

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For preschool children with type 1 diabetes, twice-daily insulin injections do not adequately control blood sugar levels, researchers report. They found these kids had frequent and prolonged episodes of either low or high blood sugar.

The study also suggests that use of a continuous glucose monitoring system does a better job of tracking daily glucose trends than does self-monitoring of blood glucose with finger-stick devices, and is well tolerated by patients and their families.

Dr. George S. Jeha, from Texas Children’s Hospital in Houston, and colleagues used the Medtronic MiniMed continuous glucose monitoring system to see what happened to blood sugar levels in 10 children younger than age 6 with type 1 diabetes over a 72-hour period.

All of the children were on twice-daily injections of rapid- and intermediate-acting insulin, and their condition was considered “well controlled,” according to the team’s report in the medical journal Diabetes Care

Jeha noted in comments to Reuters Health that “most of children spent a significant amount of time (6 percent of a 24-hour period)” with low blood sugar levels, or hypoglycemia. “Each child on average had at least one hypoglycemia episode per day lasting close to 1 hour.”

These hypoglycemic episodes occurred mainly when the children were asleep, and therefore went undetected on finger-stick measurements.

Equally concerning, Jeha said, is that when those children were not hypoglycemic they were typically running high glucose values. “Almost 50 percent of a 24-hour period” is spent with values greater than 200, he said, when the normal range is 80-120.

“The third important finding,” Jeha emphasized, is that all of these kids were considered well controlled, based on their percentage of hemoglobin A1c—an indicator of glucose levels over the long term.

He said his study shows that hemoglobin A1c “is not a very reliable predictor of good control and only reflects the average of extreme high and extreme low glucose values, thus giving a false reassurance that the patient is doing well when in fact he or she is not.”

Jeha believes that the management of young children with type 1 diabetes needs to change to improve the control of their disease. He said that his team has just completed a study showing that insulin pump therapy significantly improves control and lifestyle in diabetic children.

SOURCE: Diabetes Care, December 2004.

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