SummaryIn a double-blind crossover study the symptomatic and metabolic effects of propranolol, acebutolol, and atenolol were studied during insulin-induced hypoglycaemia in diabetics treated with diet or hypoglycaemic tablets. All the drugs prevented tachycardia, but did not affect the other symptoms of hypoglycaemia. Propranolol delayed the recovery of the blood glucose concentration and impaired the secondary rise in the concentrations of blood lactate and non-esterified fatty acids in diet-treated diabetics. Acebutolol potentiated the hypoglycaemic effect of insulin in tablet-treated diabetics (mean difference of blood glucose concentration 0 7 mmol/l (12 6 mg/100 ml)) and this difference was maintained during the recovery phase4 the blood lactate response was also impaired. Atenolol did not differ perceptibly from placebo in its effects on the metabolic responses to acute hypoglycaemia.The results may be explained by differences in the known pharmacological actions of these drugs. They support the hypothesis that beta-adrenoreceptor blocking drugs that are highly beta, specific and without membrane-stabilising activity should be safer than the non-selective drugs when used in diabetic patients at risk from hypoglycaemia.
St James's Hospital, Leeds LS9 7TF S P DEACON, MB, cHB, house physician D BARNETT, MRCP, consultant physician sity of induced hypoglycaemia was identical for atenolol, propranolol, and placebo. Propranolol prolonged hypoglycaemia, but atenolol did not. Atenolol may therefore4 be safe for use in patients receiving insulin.
I The effects of selective and non-selective ,-adrenoceptor blockade upon plasma non-esterified fatty acid concentrations in the fasting state and following insulin stress have been studied in normal subjects. 2 Atenolol, propranolol and placebo were compared in a double-blind cross-over trial in eight normal subjects. 3 Atenolol and propranolol significantly lowered plasma non-esterified fatty acid concentrations by a similar degree in the fasting, non-stressed state. This finding suggests that ,B-adrenoceptors are involved in the control of basal lipolysis. 4 Following insulin-induced stress, lower plasma non-esterified fatty acid concentrations were observed with propranolol than with atenolol. This difference may be due to P2-adrenoceptor involvement in the stress mechanisms controlling lipolysis, or to the differences in the water-lipid solubility properties of these drugs.
(90-120 mm Hg), being individual to the patient (but it should be reassessed every 1-3 months). The narrower equivalent range of 13-15 kPa-with a critical arithmetic mean of 14 kPa (105 mm Hg)-could, however, be used; only extensive statistical evaluation will determine the most clinically realistic range. Comment Nurses and midwives have shown interest in the use of kilopascals; in our practice the nurses have asked for their wall sphygmomanometer in the treatment room to be recalibrated. Insurance societies in my experience have accepted kilopascals in insurance reports. Consultants are amused and say that they always check blood pressure in their own way; but clinicians could give a lead here-and in any case teaching hospitals are starting to teach students kilopascals and their eventual adoption is intended officially.
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