Preference for high-carbohydrate foods does not change for children and adolescents in insulin-induced hypoglycemia

Abstract

Introduction: Hypoglycemia elicits coordinated counter-regulatory neuroendocrine responses. The extent to which this process involves an increased drive to eat, together with greater preference for foods high in carbohydrate content, is unclear. Our objective was to examine this effect in children and adolescents (age 5-19 years) without diabetes and no prior known experience of hypoglycemic episodes.

Research design and methods: We administered a computerised task designed to examine preference for high-carbohydrate foods (sweet and savory) to pediatric patients (n=26) undergoing an insulin tolerance test as part of the routine clinical assessment of pituitary hormone secretory capacity. The task was completed at baseline and three time points after intravenous infusion of insulin (approximately 7, 20 and 90 min).

Results: Although all patients reached insulin-induced hypoglycemia (mean venous glucose at nadir=1.9 mmol/L), there was moderate evidence of no effect on preference for high-carbohydrate foods (moderate evidence for the null hypothesis) compared with euglycemia. Patients also did not display an increase in selection of foods of high compared with low energy density. Sensitivity of the task was demonstrated by decreased preference for sweet, high-carbohydrate foods after consumption of sweet food and drink.

Conclusions: Results support the view that acute hypoglycemia does not automatically prompt the choice of high-carbohydrate foods for rapid glucose restoration, and further stresses the importance that people and families with children vulnerable to hypoglycemic episodes ensure that 'rapidly absorbed glucose rescue therapy' is always available.

Keywords: Carbohydrates; Diabetes Complications; Food Choice; Hypoglycemia.

Figure 1

Blood glucose response to administration of insulin. Blue line: clinical threshold for hypoglycemia (2.6 mmol/L).

Figure 2

Number of times participants (n=26) selected images of foods that were (A) high in carbohydrate and savory, and (B) high carbohydrate and sweet in the food preference task. Data are split across assessment time point: before insulin administration (baseline), when experiencing hypoglycemia (venous glucose <2.6 mmol/L, except for one participant with concentrations of 2.7 mmol/L), and at the end of the ITT after appropriate treatment (recovered). ANOVA, analysis of variance; ITT, insulin tolerance test.

Figure 3

Number of gummy bears participants (n=24) selected at each time point of assessment. ns, not significant.