MMPAD Milan Meeting Report

13 European Roadshow - Milan, 29 June 2018 MEETING REPORT Risk factors for hypoglycaemia The pathogenesis of hypoglycaemia resides in an imbalance between dietary carbohydrate (CHO) consumed, physical exercise, and the insulin dose administered. Risk factors of hypoglycaemia include : 15 • age under 6 years • low levels of HbA1c • lack of awareness of hypoglycaemia • past episodes of severe hypoglycaemia • long-standing diabetes. Age is a major risk factor for high glycemic variability that characterises early childhood. Another critical age is that of adolescence, typically for irregular lifestyles and alcohol consumption. Insulin therapy and hypoglycaemia In terms of insulin therapy, regular insulin is preferred over rapidly-acting analogues, which are more physiological, but expose the patient to high peaks. New long-term analogues are also good (particularly glargine and degludec). Recently, infusion pumps with auto sensors have led to the rate of severe hypoglycaemia being halved, especially at night. These new technologies give positive and reproducible results, meaning it is no longer necessary to correct hypoglycaemia with food, a practice that still tends to disrupt the metabolic system. Exercise and hypoglycaemia Exercise has a strong potential impact on hypoglycaemia via : 17 • increased glucose oxidative disposal • increased insulin-sensitivity • exhaustion of glycogen stores • counter-regulatory hormone deficiency induced by physical exercise (and training level). It is particularly difficult to quantify physical exertion in young children and, consequently, to correctly predict consumption and insulin dose. Other risk factors for hypoglycaemia may emerge in relation to physical activity and insulin therapy, such as: • wrong insulin dose • insulin injection site An extract from Professor Maffeis‘ presentation is available here