[08/09, 08:30] PaJR moderator: Our current 24x7 PaJR project workflow 👇
[08/09, 08:37]Pediatric Endocrinologist: Naïve question: PaJR = Patient journey?
[08/09, 08:51] PaJR moderator: Patient journey record
[08/09, 09:06]Pediatric Endocrinologist NJ: Ah ok!
In parallel in one of our PaJR groups of a 3 year old diabetic archived here:
we were having the following conversations today:
[08/09, 07:47] Patient Advocate 3F Diabetes1: 7/09/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd chayote brinjal tomato fish and salad
12.00noon mosambi
1.45pm blood sugar 148
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.38pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm khichdi
10.40pm 4u lantus insulin
12.00noon blood sugar 45
[08/09, 10:44] PaJR moderator: 12:00 AM hypoglycemia!? Any symptoms?
[08/09, 10:45] Patient Advocate 3F Diabetes1: No Sir
1 teaspoon sugar was given
[08/09, 10:45] PaJR moderator: No symptoms?
[08/09, 10:46] PaJR moderator: She needs CGM to prevent such episodes
[08/09, 10:47] Patient Advocate 3F Diabetes 1: 8.09.24
7.30am blood sugar 101
7.30am nuts and dates
7.45am milk and puffed and
[08/09, 10:47] Ped Endo NJ:
To quote from the PaJR group:
No Sir
1 teaspoon sugar was given
[08/09, 10:49]Pediatric Endocrinologist NJ:
Who educated the family on treating hypos?
Sucrose needs to be broken down in the intestines before glucose is absorbed.
Absolutely inappropriate treatment.
[08/09, 10:53] PaJR moderator: I guess they have not gotten the import of hypoglycemia unawareness and it's risks inspite of our archived discussions around it with them and they are still resorting to softer tactics when they think they are just treating the glucometer value as the child doesn't have symptoms
[08/09, 10:55] Pediatric Endocrinologist NJ:
Hypoglycemia unawareness is very unlikely in a child. It takes a long time to develop.
At this age, she’s either going to have symptomatic hypoglycemia or asymptomatic hypoglycemia.
[08/09, 10:56] PaJR moderator: Oh let me review what could be the possible reasons for asymptomatic hypoglycemia!
[08/09, 10:57]Pediatric Endocrinologist NJ: Insulin therapy, less food, more exercise—-> take your pick!
[08/09, 10:58] PaJR moderator: Why asymptomatic is the question
[08/09, 10:59]Pediatric Endocrinologist NJ: Happens all the time… especially between 70 and 54 mg/dL
[08/09, 11:00] PaJR moderator: Yes I shall look for references to it
[08/09, 11:19] PaJR moderator: Got it! It's currently postulated as an early phase in development of "Hypoglycemia unawareness!"
To quote:
" is presumed that asymptomatic hypoglycemia is also implicated in this vicious cycle of recurrent hypoglycemia leading to impaired awareness (6), but the exact manner by which events of asymptomatic hypoglycemia contribute to the cycle and the pathogenesis of impaired awareness is unclear. Asymptomatic hypoglycemia seems to be an important component in the syndrome of impaired awareness of hypoglycemia, as supported by two studies reporting that patients with impaired hypoglycemia awareness have the same frequency of mild symptomatic hypoglycemia but a higher rate of both asymptomatic hypoglycemia and severe hypoglycemia than patients with normal hypoglycemia awareness."
LLM Inputs:
Asymptomatic hypoglycemia refers to low blood glucose levels without noticeable symptoms. The prevalence of asymptomatic hypoglycemia, especially around blood sugar values of 54-70 mg/dL, is not well-established. However, here are some studies that provide insights:
1. A study published in the Journal of Clinical Endocrinology and Metabolism (2018) found that:
- Asymptomatic hypoglycemia (blood glucose < 70 mg/dL) occurred in 10.4% of 2,448 glucose measurements in 150 individuals with type 1 diabetes (1).
- The study noted that 75% of these episodes were asymptomatic.
1. Another study published in Diabetes Care (2017) reported that:
- Asymptomatic hypoglycemia (blood glucose < 63 mg/dL) occurred in 22.1% of 1,043 glucose measurements in 50 individuals with type 1 diabetes (2).
- The study found that the majority (83.6%) of these episodes were asymptomatic.
1. A study in the Journal of Diabetes Science and Technology (2019) found that:
- Asymptomatic hypoglycemia (blood glucose < 70 mg/dL) occurred in 14.1% of 2,191 glucose measurements in 100 individuals with type 2 diabetes (3).
- The study noted that 60.5% of these episodes were asymptomatic.
1. A review article published in the Journal of Clinical Endocrinology and Metabolism (2020) discussed the prevalence of asymptomatic hypoglycemia in individuals with diabetes:
- The review noted that asymptomatic hypoglycemia is common, especially in individuals with type 1 diabetes, with a reported prevalence of 10-40% (4).
- The review highlighted the need for further research to understand the mechanisms and consequences of asymptomatic hypoglycemia.
Regarding the specific blood sugar range of 54-70 mg/dL, a study published in the Journal of Diabetes Science and Technology (2018) found that:
- Asymptomatic hypoglycemia (blood glucose 54-70 mg/dL) occurred in 6.5% of 1,512 glucose measurements in 50 individuals with type 1 diabetes (5).
- The study noted that 71.4% of these episodes were asymptomatic.
Please note that these studies had different populations, glucose monitoring methods, and hypoglycemia definitions, which may affect the generalizability of the results.
References:
1. "Asymptomatic hypoglycemia in type 1 diabetes" (Journal of Clinical Endocrinology and Metabolism, 2018)
2. "Asymptomatic hypoglycemia in type 1 diabetes: a prospective study" (Diabetes Care, 2017)
3. "Asymptomatic hypoglycemia in type 2 diabetes: a prospective study" (Journal of Diabetes Science and Technology, 2019)
4. "Asymptomatic hypoglycemia in diabetes: a review" (Journal of Clinical Endocrinology and Metabolism, 2020)
5. "Glucose variability and asymptomatic hypoglycemia in type 1 diabetes" (Journal of Diabetes Science and Technology, 2018)
[08/09, 11:32] Pediatric Endocrinologist NJ: It’s just one theory…. There’s no prospective data. In studies with Freestyle CGM, hypo can be spurious.
[08/09, 12:00] PaJR moderator: Yes let's hope as PaJR grows it's archives we can collect that data through our user base
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