Discussion
hypoglycemia
HYPOGLYCEMIA, SECONDARY, SPONTANEOUS HYPOGLYCEMIA
For insulin-induced NS-H, an initial CHO intake of 32 g compared to 16 g of CHO at the 3.0–3.5 mmol/L hypoglycemic range showed some benefits. This resonates with real-life practices of PWT1D who consumed averages of 32 g of CHO (In our study, an increase in PG at 15 min post-treatment with 16 g of CHO was similar to that reported by a recent study (0.85 mmol/L) (As previously mentioned, we chose 32 g of CHO for initial consumption based on averages reported in real-life patients’ practices (This potential advantage of an initial 32 g of CHO at a PG range of 3.0-3.5 mmol/L was not seen at lower hypoglycemia at which more intense and unpleasant symptoms were reported (data not shown) (The pooled data were limited by its secondary analysis nature but it leads to interesting observations. It demonstrated that both absolute glucose levels and its rates of change (data that can be obtained with glucose sensors) and possibly rates of change of plasma insulin levels (research in progress designing insulin sensors) were positively associated with change of PG at 15 min (Mini-doses of glucagon could be an alternative to oral CHO in NS-H, especially to avoid additional caloric intake with the increased prevalence of excess weight in PWT1D (Our study had some limitations. Subcutaneous insulin could result in inter-patient variability due to differences in absorption, but it is more representative of real-life conditions than the historical use of the intravenous route. These results need replication during spontaneous hypoglycemia episodes in diverse free-living conditions using glucose sensors or capillary values and in pediatric populations. Alternate ways to treat NS-H should be investigated. We strongly believe that CHO intake at glucose thresholds higher than 4 mmol/L to prevent reaching serious hypoglycemia levels needs to be investigated.In conclusion, this study has confirmed treatment difficulties of insulin-induced NS-H with the current guidelines. While it did not aim to change those guidelines, it added one important piece to the puzzle. Advantages of higher initial CHO consumption in some circumstances and treatment at higher glucose thresholds or ranges should be further reproduced in other trials and settings. This study adds to the scarce literature needed to fine-tune the treatment approach for this daily struggle for PWT1D and asserts the need to conduct other trials to cover various clinical scenarios and conditions of NS-H (