Hypoglycemia in type 1A diabetes can develop before insulin therapy: A retrospective cohort study

Diabetes Res Clin Pract. 2019 Jan;147:87-92. doi: 10.1016/j.diabres.2018.11.011. Epub 2018 Nov 24.


Aims: There are as yet no cohort studies of hypoglycemia in type 1 diabetes before starting insulin therapy. Our aim was to determine the frequency and clinical features of hypoglycemia in patients with type 1A diabetes prior to commencing insulin therapy.

Methods: Eighty-seven patients with type 1A diabetes were enrolled, and a retrospective chart review of the patients was conducted.

Results: Hypoglycemia before insulin therapy occurred in six of 87 patients (6.9%). The HbA1c levels at the diagnosis of type 1A diabetes in the hypoglycemia group were lower than in the non-hypoglycemia group (median: 7.3% (56 mmol/mol) vs. 11.9% (106 mmol/mol), p < 0.0001). Similarly, the 24-hour urinary C-peptide (UCPR) levels of the former group were higher than those of the latter group (16.5 μg/day/m2 vs. 7.0 μg/day/m2, p = 0.0075). Hypoglycemic episodes occurred mostly in the postprandial period and gradually disappeared with a decrease in insulin secretion.

Conclusions: We demonstrated that some patients with type 1A diabetes experience hypoglycemic episodes before insulin therapy. Patients with early-stage type 1A diabetes with relatively low HbA1c or high UCPR have a risk of hypoglycemia. These findings may impact when and how insulin is introduced in the treatment of early-stage type 1A diabetes.

Keywords: Early-stage; Insulin; Postprandial hypoglycemia; Retrospective study; Type 1 diabetes.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / pathology
  • Female
  • Humans
  • Hypoglycemia / etiology*
  • Hypoglycemia / pathology
  • Insulin / pharmacology
  • Insulin / therapeutic use*
  • Male
  • Retrospective Studies


  • Insulin