Experience of severe hypoglycaemia may influence both patient's and physician's subsequent treatment policy of insulin-dependent diabetes mellitus

Daily insulin doses and HbAl(c) were studied 0-3 months before and 2-6, 7-11, and 12-16 months after 48 consecutive episodes of severe hypoglycaemia (coma and/or convulsion) in children and adolescents with insulin-dependent diabetes mellitus. After 69% of the attacks, either physicians or patients or both decreased daily insulin doses (for the whole group, mean +/- SD: 0-3 months before the episode 0.93 +/- 0.20 U/kg vs 2-6 months after 0.84 +/- 0.20 U/kg, P < 0.001), which may have worsened the subsequent glycaemic control as evidenced by a significant increase in HbAl(c) (8.3 +/- 1.5% vs 9.1 +/- 1.8%, P < 0.001, respectively). Physicians decreased the insulin dose even in 14 of the 33 patients with a preventable cause for their hypoglycaemia other than erroneous excess of insulin.