Detection of nocturnal hypoglycemia in children with Typ I diabetes mellitus

摘要

Nocturnal hypoglycemias occur in most diabetic children but only a small part of the children show severe symptomes as seizures and unconsciousness. Hypoglycemia is a potent stimulus for the hypothalamo-pituitary-adrenal axis resulting in a rise of plasma cortisol. MOORE was the first to report that a raised early morning urinary cortisol/creatinine ratio of 55×10-6 may therefore indicate nocturnal hypoglycemia in adult diabetics. In 23 diabetic children the cortisol/creatinine ratio was determined in 1.) early morning urine samples and 2.) overnight urine samples without early morning urine voidings.The cortisol/creatinine ratio in early morning urine did not differ in children with and without nocturnal hypoglycemia (33 + 10×10-6 vs 35 + 12×10-6). Whereas the cortisol/creatinine ratio in overnight urine samples was significantly higher in children with nocturnal hypoglycemia compared to euglycemic children (5 + 2×10-6 vs 31 + 10×10-6 p< 0.01).Our results suggest that the cortisol/creatinine ratio in early morning urine is mainly influenced by the diurnal variation of cortisol secretion whereas in overnight urine sampling the cortisol/creatinine ratio can serve as an indicator for nocturnal hypoglycemia.