Frontiers in Endocrinology (Jun 2024)

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

  • Stefano Zucchini,
  • Stefano Tumini,
  • Andrea Enzo Scaramuzza,
  • Riccardo Bonfanti,
  • Maurizio Delvecchio,
  • Roberto Franceschi,
  • Dario Iafusco,
  • Lorenzo Lenzi,
  • Enza Mozzillo,
  • Stefano Passanisi,
  • Claudia Piona,
  • Ivana Rabbone,
  • Novella Rapini,
  • Andrea Rigamonti,
  • Carlo Ripoli,
  • Giuseppina Salzano,
  • Silvia Savastio,
  • Riccardo Schiaffini,
  • Angela Zanfardino,
  • Valentino Cherubini,
  • Diabetes Study Group of the Italian Society for Pediatric Endocrinology Diabetes,
  • Albino Claudia Accursia,
  • Aloe Monica,
  • Anzelotti Maria Teresa,
  • Arnaldi Claudia,
  • Barbetti Fabrizio,
  • Bassi Marta ,
  • Berioli Maria Giulia,
  • Bernardini Luca,
  • Bertelli Enrica,
  • Biagioni Martina,
  • Bobbio Adriana,
  • Bombaci Bruno,
  • Bonfanti Riccardo,
  • Bonura Clara,
  • Bracciolini Giulia Patrizia,
  • Bruzzese Mariella,
  • Bruzzi Patrizia,
  • Buono Pietro,
  • Buscarino Piera,
  • Cadario Francesco,
  • Calcaterra Valeria,
  • Calzi Elena ,
  • Cappa Marco,
  • Cardani Roberta ,
  • Cardella Francesca,
  • Cardinale Giuliana Marcella,
  • Casertano Alberto,
  • Castorani Valeria,
  • Cauvin Vittoria,
  • Cenciarelli Valentina,
  • Ceruti Franco,
  • Cherubini Valentino,
  • Chiarelli Francesco,
  • Chiari Giovanni,
  • Cianfarani Stefano,
  • Cicchetti Mario,
  • Cipriano Paola,
  • Cirillo Dante,
  • Citriniti Felice,
  • Coccioli Maria Susanna,
  • Confetto Santino,
  • Contreas Giovanna,
  • Coro Anna,
  • Correddu Antonella,
  • Corsini Elisa,
  • Crino’ Antonino,
  • d’Annunzio Giuseppe,
  • De Berardinis Fiorella,
  • De Donno Valeria,
  • De Filippo Gianpaolo,
  • De Marco Rosaria,
  • De Sanctis Luisa,
  • Del Duca Elisabetta,
  • Delvecchio Maurizio ,
  • Deodati Annalisa,
  • Di Bonito Procolo,
  • Di Candia Francesca,
  • Faleschini Elena,
  • Fattorusso Valentina,
  • Favia Anna ,
  • Federico Giovanni,
  • Felappi Barbara,
  • Ferrari Mara,
  • Ferrito Lucia,
  • Fichera Graziella,
  • Fontana Franco,
  • Fornari Elena,
  • Franceschi Roberto ,
  • Franco Francesca,
  • Franzese Adriana,
  • Frongia Anna Paola,
  • Frontino Giulio,
  • Gaiero Alberto,
  • Galassi Sabrina Maria,
  • Gallo Francesco,
  • Gargantini Luigi,
  • Giani Elisa,
  • Gortan Anna Jolanda,
  • Graziani Vanna,
  • Grosso Caterina,
  • Gualtieri Antonella ,
  • Guasti Monica,
  • Guerraggio Lucia Paola,
  • Guzzetti Chiara,
  • Iafusco Dario,
  • Iannicelli Gennaro,
  • Iezzi Maria Laura,
  • Ignaccolo Maria Giovanna,
  • Innaurato Stefania,
  • Inzaghi Elena,
  • Iovane Brunella,
  • Iughetti Lorenzo,
  • Kaufmann Peter,
  • La Loggia Alfonso,
  • Lambertini Anna Giulia,
  • Lapolla Rosa,
  • Lasagni Anna,
  • Lazzaro Nicola,
  • Lazzeroni Pietro,
  • Lenzi Lorenzo,
  • Lera Riccardo,
  • Levantini Gabriella ,
  • Lezzi Marilea,
  • Lia Rosanna,
  • Liguori Alice,
  • Lo Presti Donatella,
  • Lombardo Fortunato,
  • Lonero Antonella,
  • Longhi Silvia,
  • Lorubbio Antonella,
  • Lucchesi Sonia,
  • Maccioni Rosella,
  • Macedoni Maddalena,
  • Macellaro Patrizia Cristiana,
  • Madeo Simona Filomena,
  • Maffeis Claudio,
  • Mainetti Benedetta,
  • Maltoni Giulio ,
  • Mameli Chiara,
  • Mammì Francesco,
  • Manca Bitti Maria Luisa,
  • Mancioppi Valentina,
  • Manco Melania,
  • Marigliano Marco,
  • Marino Monica,
  • Marsciani Alberto,
  • Matteoli Maria Cristina,
  • Mazzali Elena,
  • Minute Marta,
  • Minuto Nicola,
  • Monti Sara,
  • Morandi Anita,,
  • Morganti Gianfranco,
  • Morotti Elisa,
  • Mozzillo Enza,
  • Musolino Gianluca,
  • Olivieri Francesca,
  • Ortolani Federica,
  • Pampanini Valentina,
  • Pardi Daniela,
  • Pascarella Filomena,
  • Pasquino Bruno,
  • Passanisi Stefano,
  • Patera Ippolita Patrizia,
  • Pedini Annalisa,
  • Pennati Maria Cristina,
  • Peruzzi Sonia,
  • Peverelli Paola,
  • Pezzino Giulia,
  • Piccini Barbara,
  • Piccinno Elvira Eugenia Rosaria,
  • Piona Claudia,
  • Piredda Gavina,
  • Piscopo Alessia,
  • Pistone Carmelo,
  • Pozzi Erica,
  • Prandi Elena,
  • Predieri Barbara,
  • Prudente Sabrina,
  • Pulcina Anna,
  • Rabbone Ivana,
  • Randazzo Emioli,
  • Rapini Novella,
  • Reinstadler Petra,
  • Riboni Sara,
  • Ricciardi Maria Rossella,
  • Rigamonti Andrea,
  • Ripoli Carlo,
  • Rossi Virginia,
  • Rossi Paolo,
  • Rutigliano Irene,
  • Sabbion Alberto,
  • Salvatoni Alessandro,
  • Salvo Caterina,
  • Salzano Giuseppina,
  • Sanseviero Mariateresa ,
  • Savastio Silvia,
  • Savini Rosanna,
  • Scanu Mariapiera,
  • Scaramuzza Andrea Enzo,
  • Schiaffini Riccardo,
  • Schiavone Maurizio,
  • Schieven Eleonardo,
  • Scipione Mirella,
  • Secco Andrea ,
  • Silvestri Francesca,
  • Siri Giulia,
  • Sogno Valin Paola,
  • Sordelli Silvia,
  • Spiri Daniele,
  • Stagi Stefano ,
  • Stamati Filomena Andreina,
  • Suprani Tosca,
  • Talarico Valentina,
  • Tiberi Valentina,
  • Timpanaro Tiziana Antonia Lucia,
  • Tinti Davide,
  • Tirendi Antonina,
  • Tomaselli Letizia Grazia,
  • Toni Sonia,
  • Torelli Cataldo,
  • Tornese Gianluca,
  • Trada Michela,,
  • Trettene Adolfo Andrea,
  • Tumini Stefano,
  • Tumminelli Marilena,
  • Valerio Giuliana,
  • Vandelli Sara,
  • Ventrici Claudia,
  • Zampolli Maria,
  • Zanatta Manuela ,
  • Zanfardino Angela,
  • Zecchino Clara,
  • Zonca Silvia,
  • Zucchini Stefano

DOI
https://doi.org/10.3389/fendo.2024.1387537
Journal volume & issue
Vol. 15

Abstract

Read online

There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.

Keywords