Ask the Experts - Is the Brain Affected By Recurrent Asymptomatic...

Ask the Experts - Is the Brain Affected By Recurrent Asymptomatic...
What is the effect of recurrent hypoglycemic events on young children, especially the asymptomatic events that we don't recognize? Could they harm the brain or the development of the child in any way?

Nada Haddad, MD

I believe that your question regarding unrecognized hypoglycemic events refers to asymptomatic hypoglycemia. Asymptomatic hypoglycemia may occur in young children who may not know how to recognize hypoglycemia or who can recognize the symptoms but not be able to name them. Helping children to recognize and name the symptoms associated with low blood sugars by asking "How did you feel when your blood sugar was this low?" may be effective.

The incidence of true asymptomatic hypoglycemia and its neurological and developmental effects on children have been difficult to establish. Frequent nocturnal blood sampling studies have shown that asymptomatic nocturnal hypoglycemia can occur in up to 50% of children who receive conventional treatment for their diabetes, especially younger children and children with tighter diabetes control. Adolescents may experience asymptomatic hypoglycemia, especially if they are undergoing tight glycemic control.

Whereas the effects of asymptomatic hypoglycemia on long-term neurological and cognitive function in children are not known, recent data indicate that some children may exhibit impaired intellectual performance during times of low blood glucose levels. However, long-term neurological and developmental sequelae of hypoglycemia are not usually evident unless the hypoglycemia is severe, long lasting, and/or recurrent. Prevention of hypoglycemia, especially nocturnal hypoglycemia, through optimization of insulin treatment programs and setting higher blood glucose and glycohemoglobin target ranges appears prudent especially in younger children.