Dynamics of glucose concentration changes during ketogenic diet initiation in pediatric patients with drug-resistant epilepsy – analysis of glucose values in individual patients

Czech version

Authors: K. Brožová ^1,2; J. Michalec ³; M. Brabec ⁴; P. Bořilová ¹; E. Povolná ³; P. Kohout ^2,5; J. Brož ³
Authors‘ workplace: Oddělení dětské neurologie, Fakultní, Thomayerova nemocnice, Praha ¹; 3. LF UK Praha ²; Interní klinika 2. LF UK a FN Motol, Praha ³; Ústav informatiky, AV ČR, v. v. i. ⁴; Interní klinika 3. LF UK a FN Motol, Praha ⁵
Published in: Cesk Slov Neurol N 2024; 87(3): 197-207
Category: Original Paper
doi: https://doi.org/10.48095/csbb2024197

Overview

Aim: The aim was to analyze individual changes in glucose concentration before starting the ketogenic diet (KD) and during the first 5 days of its use in individual non-diabetic children with drug-resistant epilepsy. Subjects and methodology: Ten pediatric patients with pharmaco-resistant epilepsy started on KD according to a non-fasting KD protocol with a ketogenic ratio (KR) that gradually increased day by day from 1 : 1, 2 : 1, 3 : 1 to 3.5 : 1. Continuous glucose monitoring (CGM) was performed 36 h before initiation and then over 5 days during increasing KR. Results: Mean glycemic control estimates for each dietary ratio ranged from 6.03 (95% confidence interval [CI] 5.92–6.14) mmol/l on a normal diet to 2.56 (CI 95%: 2.46–2.66) mmol/l on 3.5 : 1 KR within all measured values and from 4.91 (CI 95%: 4.75–5.06) mmol/l on a normal diet to 1.85 (CI 95%: 1.53–2.17) mmol/l on 3.5 : 1 KR within fasting values measured between 5:00 a.m. and 6:00 a.m. CGM showed hypoglycemic events during KD initiation in 9 patients. Conclusion: Analysis of individual patient data showed a trend of gradually decreasing glycemia with increasing KR. This trend seems to be stronger for all data obtained compared to those during fasting (period 5.00–6.00 am). In most patients, episodes of asymptomatic hypoglycemia were captured during diet initiation.

Keywords:

ketogenic diet – drug-resistant epilepsy – glucose concentration – pediatric patients

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