Symptomatic hypoglycemia in children and adolescents with type 1 diabetes mellitus in Sudan

Objectives: to determine the prevalence of symptomatic hypoglycemia, its perceived causes and its relationship to metabolic control in young diabetic Sudanese patients. Design: Prospective Cohort Study subjects: Eighty-four patients below the age of 20 with type I (insulin-dependent) diabetes mellitus attending the diabetes center at the University Hospital in Khartoum. Results: Although the glycemic control of this group of patients was poor (average HbAlc = 12.6%), 48 children of the 76 patients who completed the trial experienced 227 attacks over a period of 28 weeks. Palpitations and tremors were the most common initial symptoms reported by half of the patients, followed by dizziness, hunger and headache. The main precipitating factors of the episodes were: missed meals, wrong insulin dose and physical exercise. The majority of the episodes were mild reactions and only 29 (12.8%) were severe. Of the latter group, two episodes were associated with seizures, 5 patients went into coma, 3 episodes ended with motor aphasia and one patient died. No significant associations were found between the average glycated hemoglobin concentration and the frequency or severity of hypoglycemia in this group of patients. Conclusions: Poor metabolic control is not a safeguard against hypoglycemia in diabetic children and adolescents.