A Sense of Where They Are: Children, Parents, and Lows
Severe low blood glucose (hypoglycemia) can be terrifying and dangerous. In the worst cases, seizures or coma can result. Preventing hypoglycemia can be especially challenging for children. But it may be even more difficult for their parents, according to a new study.
The research, published in the Mar. 2008 issue of Pediatrics, tested the ability of 6- to 11-year-olds with type 1 diabetes and their parents to accurately estimate blood glucose. "They both did terribly, but the parents were even worse," says lead author Linda Gonder-Frederick, PhD, an associate professor at the University of Virginia.
The 61 families enrolled in the study estimated the children's current blood glucose three to four times a day, in addition to those times when they thought the glucose might be too low or high. The researchers then compared their estimates with actual measures of the children's blood glucose.
After 70 blood glucose estimation trials over one month, the researchers tallied the scores. Children did somewhat better than their parents, detecting hypoglycemia 54 percent of the time, compared with 41 percent for their parents. The researchers were particularly concerned to see parents guessing a high level 17 percent of the time when the blood glucose was actually low.
"Clinically, it's a very serious error, because you would take the opposite treatment actions," says Gonder-Frederick. For example, a parent working under the assumption that a child is hyperglycemic may limit food intake, which could make hypoglycemia worse.
During six months of follow-up, the researchers sent an e-mail to parents every two weeks asking how many times their children experienced severe hypoglycemic episodes. They found that children who scored lowest on detecting hypoglycemia during the trial period were most likely to suffer severe hypoglycemia. "That's one of the major take home messages," says Gonder-Frederick: "Hypoglycemia unawareness is a risk factor for future severe hypoglycemia."
Children were worse at estimating their glucose levels if they were younger, had fluctuating levels, or were depressed. And yet anxiety seemed to help children detect hypoglycemia. "Anxiety is associated with hypervigilance," explains Gonder-Frederick. "Hypervigilance of symptoms … can cause people to be more aware of body changes." Of course, anxiety brings its own problems in the form of stress and unhappiness.
As for parents, the duration of their child's diabetes and the ability to recognize symptoms of hypoglycemia improved blood glucose estimation accuracy. Yet, surprisingly, better predictions by parents did not translate into a reduction of severe hypoglycemia. "One thing we learned: Parents of young children need a lot more education on hypoglycemia. A lot more," says Gonder-Frederick, noting that she and her colleagues are developing a training course to help fill that need.