AUTHOR=Zucchini Stefano , Tumini Stefano , Scaramuzza Andrea Enzo , Bonfanti Riccardo , Delvecchio Maurizio , Franceschi Roberto , Iafusco Dario , Lenzi Lorenzo , Mozzillo Enza , Passanisi Stefano , Piona Claudia , Rabbone Ivana , Rapini Novella , Rigamonti Andrea , Ripoli Carlo , Salzano Giuseppina , Savastio Silvia , Schiaffini Riccardo , Zanfardino Angela , Cherubini Valentino , Diabetes Study Group of the Italian Society for Pediatric Endocrinology Diabetes , Accursia Albino Claudia , Monica Aloe , Teresa Anzelotti Maria , Claudia Arnaldi , Fabrizio Barbetti , Marta Bassi , Giulia Berioli Maria , Luca Bernardini , Enrica Bertelli , Martina Biagioni , Adriana Bobbio , Bruno Bombaci , Riccardo Bonfanti , Clara Bonura , Patrizia Bracciolini Giulia , Mariella Bruzzese , Patrizia Bruzzi , Pietro Buono , Piera Buscarino , Francesco Cadario , Valeria Calcaterra , Elena Calzi , Marco Cappa , Roberta Cardani , Francesca Cardella , Marcella Cardinale Giuliana , Alberto Casertano , Valeria Castorani , Vittoria Cauvin , Valentina Cenciarelli , Franco Ceruti , Valentino Cherubini , Francesco Chiarelli , Giovanni Chiari , Stefano Cianfarani , Mario Cicchetti , Paola Cipriano , Dante Cirillo , Felice Citriniti , Susanna Coccioli Maria , Santino Confetto , Giovanna Contreas , Anna Coro , Antonella Correddu , Elisa Corsini , Antonino Crino’ , Giuseppe d’Annunzio , Fiorella De Berardinis , Valeria De Donno , Gianpaolo De Filippo , Rosaria De Marco , Luisa De Sanctis , Elisabetta Del Duca , Maurizio Delvecchio , Annalisa Deodati , Procolo Di Bonito , Francesca Di Candia , Elena Faleschini , Valentina Fattorusso , Anna Favia , Giovanni Federico , Barbara Felappi , Mara Ferrari , Lucia Ferrito , Graziella Fichera , Franco Fontana , Elena Fornari , Roberto Franceschi , Francesca Franco , Adriana Franzese , Paola Frongia Anna , Giulio Frontino , Alberto Gaiero , Maria Galassi Sabrina , Francesco Gallo , Luigi Gargantini , Elisa Giani , Gortan Anna Jolanda , Vanna Graziani , Caterina Grosso , Antonella Gualtieri , Monica Guasti , Paola Guerraggio Lucia , Chiara Guzzetti , Dario Iafusco , Gennaro Iannicelli , Laura Iezzi Maria , Giovanna Ignaccolo Maria , Stefania Innaurato , Elena Inzaghi , Brunella Iovane , Lorenzo Iughetti , Peter Kaufmann , Alfonso La Loggia , Giulia Lambertini Anna , Rosa Lapolla , Anna Lasagni , Nicola Lazzaro , Pietro Lazzeroni , Lorenzo Lenzi , Riccardo Lera , Gabriella Levantini , Marilea Lezzi , Rosanna Lia , Alice Liguori , Lo Presti Donatella , Fortunato Lombardo , Antonella Lonero , Silvia Longhi , Antonella Lorubbio , Sonia Lucchesi , Rosella Maccioni , Maddalena Macedoni , Cristiana Macellaro Patrizia , Filomena Madeo Simona , Claudio Maffeis , Benedetta Mainetti , Giulio Maltoni , Chiara Mameli , Francesco Mammì , Luisa Manca Bitti Maria , Valentina Mancioppi , Melania Manco , Marco Marigliano , Monica Marino , Alberto Marsciani , Cristina Matteoli Maria , Elena Mazzali , Marta Minute , Nicola Minuto , Sara Monti , Anita, Morandi , Gianfranco Morganti , Elisa Morotti , Enza Mozzillo , Gianluca Musolino , Francesca Olivieri , Federica Ortolani , Valentina Pampanini , Daniela Pardi , Filomena Pascarella , Bruno Pasquino , Stefano Passanisi , Patrizia Patera Ippolita , Annalisa Pedini , Cristina Pennati Maria , Sonia Peruzzi , Paola Peverelli , Giulia Pezzino , Barbara Piccini , Piccinno Elvira Eugenia Rosaria , Claudia Piona , Gavina Piredda , Alessia Piscopo , Carmelo Pistone , Erica Pozzi , Elena Prandi , Barbara Predieri , Sabrina Prudente , Anna Pulcina , Ivana Rabbone , Emioli Randazzo , Novella Rapini , Petra Reinstadler , Sara Riboni , Rossella Ricciardi Maria , Andrea Rigamonti , Carlo Ripoli , Virginia Rossi , Paolo Rossi , Irene Rutigliano , Alberto Sabbion , Alessandro Salvatoni , Caterina Salvo , Giuseppina Salzano , Mariateresa Sanseviero , Silvia Savastio , Rosanna Savini , Mariapiera Scanu , Enzo Scaramuzza Andrea , Riccardo Schiaffini , Maurizio Schiavone , Eleonardo Schieven , Mirella Scipione , Andrea Secco , Francesca Silvestri , Giulia Siri , Paola Sogno Valin , Silvia Sordelli , Daniele Spiri , Stefano Stagi , Andreina Stamati Filomena , Tosca Suprani , Valentina Talarico , Valentina Tiberi , Lucia Timpanaro Tiziana Antonia , Davide Tinti , Antonina Tirendi , Grazia Tomaselli Letizia , Sonia Toni , Cataldo Torelli , Gianluca Tornese , Michela, Trada , Andrea Trettene Adolfo , Stefano Tumini , Marilena Tumminelli , Giuliana Valerio , Sara Vandelli , Claudia Ventrici , Maria Zampolli , Manuela Zanatta , Angela Zanfardino , Clara Zecchino , Silvia Zonca , Stefano Zucchini TITLE=Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia JOURNAL=Frontiers in Endocrinology VOLUME=15 YEAR=2024 URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1387537 DOI=10.3389/fendo.2024.1387537 ISSN=1664-2392 ABSTRACT=

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.