The effectiveness of glucose, sucrose, and

fructose in treating hypoglycemia in children

with type 1 diabetes
Husband AC, Crawford S, McCoy LA, Pacaud D
Pediatric Diabetes 2010: 11: 154-158

Cally Byrne
DSME Rotation
Preceptors: Mary Julius & Neal Kurmas

Background
Diabetes Control and Complications Trial (DCCT)
Metabolic Control
Long-term Complications
Risk of Hypoglycemia
Hypoglycemia Treatment Options
Glucose tablets, juice, dried fruit, soda and candy
Factors: convenience, cost, taste and portability

Recommended Hypoglycemia Treatment

ADA: Glucose
CDA: Glucose or sucrose

Purpose
To determine the most effective treatment option for
managing naturally occurring hypoglycemia in children with
type 1 diabetes.

Objectives
Primary

Determine if fructose and

sucrose are as effective as
glucose in the treatment of
spontaneous hypoglycemia

Secondary

Pre-study and post-study

treatment preferences

Participants
Included
Diabetes Clinic at the Alberta Childrens Hospital
3 18 y.o.
Minimum 3-month duration of type 1 diabetes
Excluded
Newly diagnosed
<4 hypoglycemic events per month
Adrenal insufficiency
Uncompensated hypothyroidism
Clinical autonomic neuropathy
Celiac disease
Lack of family support
Unable to to follow the study protocols

Design & Intervention

Randomized, crossover design
Spontaneous Hypoglycemia: Blood glucose < 4.0 mmol/L (72

mg/dl)
Prepackaged treatments used 5 times each
Glucose: BD Glucose Tablets
Sucrose: Skittles
Fructose: Fruit to Go

Treatment Amount Administered

Children <10 y.o.: 10 g CHO
Children >10 y.o.: 15 g CHO
Blood glucose results & treatment methods recorded
Subjects reported their preferred treatment pre- and post-

study

Main Outcome Measured

Effectiveness of treatment as defined by a blood glucose
meter reading that was 4.0 mmol/L 15 min after treatment
out of five trials.

Statistical Analyses
MANOVA
First analysis
DV: # of successes
IV: treatment method
Repeated stratifying for age group
Second analysis
DV: pretreatment blood glucose levels
IV: treatment method

Third analysis
Analyzed posttreatment blood glucose levels across the three
treatments

Results
N=33

Treatment Failure
Glucose: 12%
Fructose: 33%
Sucrose: 12%

Mean change from pre- to post-treatment:

Glucose: 2.45 mmol/L (25 mg/dL)
Fructose: 1.30 mmol/L (13.265 mg/dL)
Sucrose: 2.47 mmol/L (25.2 mg/dL)

Results

Conclusions
Skittles = BD Glucose Tablets > Fruit to Go
Sucrose = Glucose > Fructose
Factors that influence the effectiveness
Soluble fiber
Chewing
Glycemic Index
Metabolic pathways

Should fructose be included in an acute setting for the

resolution of hypoglycemia?

Implications for Clinical Practice

Never want hypoglycemic events in the hospital, but when

they do occur, we should use evidence-based forms of

treatment
VA in the process of updating its Hypoglycemia Treatment
Guidelines

References
Husband AC, Crawford S, McCoy LA, et al. The

effectiveness of glucose, sucrose, and fructose in treating

hypoglycemia in children with type 1 diabetes. Pediatric
Diabetes 2010;11:154-158.

QUESTIONS?