Children and teens are a lot of wonderful things. “Easy” is not one of them. When dealing with pediatric diabetes, clinicians should prepare for a different clinical picture, different behaviours, and different thresholds for hypoglycaemic symptoms. They should also anticipate a high level of parental stress and worry.
Many clinicians perceive the risk of severe hypoglycaemia as firmly tethered to the level of glucose control: the tighter the control, the greater the risk. This perception has its roots in the historical association between A1C and hypoglycaemia risk, established in several studies. As a frequently cited example, the DCCT trial found a 3-fold increased risk of severe hypoglycaemia in patients randomized to the intensive management arm of the study.