In a recent journal article, researchers noted that early exposure to and high frequency of severe hypoglycemia “negatively affects long-term spatial performance” in children with type 1.

Washington University School of Medicine researchers in St. Louis, Missouri, combined data from three independent studies to obtain a sample of 103 children aged 6-18 years with type 1 along with 60 nondiabetic control subjects.

“We found that repeated severe hypoglycemia (more than three episodes) reduced long-term spatial delayed response performance, particularly when severe hypoglycemic episodes began before the age of 5 years,” write the researchers. “Age of type 1 diabetes onset and estimates of chronic hyperglycemia did not influence performance.”

—Diabetes Care, October 2005

What is Spatial Memory?

Spatial memory is the memory function that records information about one’s environment and its spatial orientation. For example, spatial memory is required in order for a person to navigate a familiar city, just as a rat’s spatial memory is needed to learn the location of food at the end of a maze.

Source: en.wikipedia.org/wiki/spatial_memory

Tamara Hershey, PhD, and Neil White, MD, were researchers on the memory study.

What are some serious repercussions of decreased spatial memory function?

Spatial memory is used in daily life in numerous ways. For instance, children may use spatial memory when they recall where they put their lunchbox when they got home, or when they learn the location of their cubby in a new classroom. However, our study does not address whether these kinds of everyday memory tasks were affected by severe hypoglycemia. Whether performance on our laboratory memory task predicts memory function in the context of everyday life remains an important area for further research.

What can parents of type 1 kids do to help alleviate severe hypos?

The first step to avoidance of severe hypoglycemia in children with type 1 diabetes is to set appropriate goals, including blood glucose targets that minimize the risk of even mild hypoglycemia. This is especially true at an age when hypoglycemia recognition is not yet fully developed (“age-associated hypoglycemia unawareness”). Many think that this age is less than 6-7 years old, but it must be very individualized.

Second, overinsulinization is inadvisable and of no demonstrated benefit. Regardless of the chosen insulin regimen, the doses should be at the lowest level, which is required to accomplish the blood glucose target. Higher dose that result in the need for repeated treatment of hypoglycemia should be avoided.

Third, although some regimens—such as using an insulin pump or taking Lantus as compared to suppertime or nighttime NPH—have been shown to reduce hypoglycemia—especially nighttime hypoglycemia—it needs to be recognized that there is no one regimen that can be recommended for all subjects. Attention to individual variation in responses to treatment is a key element of success.