Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects

Abstract

Abstract. Axelsen M, Wesslau C, Lönnroth P, Arvidsson Lenner R, Smith U (Sahlgrenska University Hospital, Göteborg University, Sweden). Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated IDDM subjects. J Intern Med 1999; 245: 229-36.Objectives. The present study tests two interrelated hypotheses: (1) that bedtime ingestion of uncooked cornstarch exerts a lower and delayed nocturnal blood glucose peak compared with a conventional snack; (2) that bedtime carbohydrate supplement, administered as uncooked cornstarch, prevents nocturnal hypoglycaemia without altering metabolic control in intensively treated type 1 diabetes (IDDM) patients. Design and subjects. The above hypotheses were tested separately (1) by pooling and analysing data from two overnight studies of comparable groups of patients with non-insulin dependent diabetes mellitus (NIDDM) (14 and 10 patients, respectively), and (2) by a double-blind, randomized 4-week cross-over study in 12 intensively treated IDDM patients. Setting. Sahlgrenska University Hospital, Göteborg, Sweden. Interventions.(1) Ingestion of uncooked cornstarch and wholemeal bread (0.6 g of carbohydrates kg Results. Bedtime uncooked cornstarch ingestion led to a lower (2.9 Ϯ 0.5 vs. 5.2 Ϯ 0.6 m, P = 0.01) and delayed (4.3 Ϯ 0.6 vs. 2.0 Ϯ 0.0 h, P Ͻ 0.01) BG peak, compared with a conventional snack, in NIDDM patients. Four weeks of bedtime uncooked cornstarch supplement, as compared with placebo, led to a 70% reduction in the frequency of self-estimated hypoglycaemia at 03.00 h (P Ͻ 0.05), without affecting HbA1c or fasting lipids in IDDM patients. Conclusions. Uncooked cornstarch, ingested at bedtime, mimicked the nocturnal glucose utilization profile following insulin replacement, with a peak in blood glucose after 4 h. In IDDM patients, bedtime uncooked cornstarch supplement diminished the number of self-estimated hypoglycaemic episodes, without adversely affecting HbA1c and lipid levels. Hence, bedtime uncooked cornstarch ingestion may be feasible to prevent a mid-nocturnal glycaemic decline following insulin replacement in IDDM and, based on the nocturnal blood glucose profile, may also be preferable compared with conventional snacks.

Insulin Autoimmune Syndrome in a Health Supplement User: The Effectiveness of Cornstarch Therapy for Treating Hypoglycemia

“…Cornstarch therapy has been reported to be useful in countering hypoglycemia in patients with glycogen storage disease type 1 and those with unstable control of type 1 diabetes (3,4). We used cornstarch to treat IAS-related hypoglycemia in the present case.…”

Glycemic index in chronic disease: a review

“…This could result in a counter-regulatory response with the release of free fatty acids, creating an insulin-resistant environment (Piatti et al, 1991;Boden et al, 1991) and reduced glucose tolerance. Ingestion of a slow release carbohydrate food (eg uncooked cornstarch) at bedtime was shown to produce a substantial suppression of nocturnal free fatty acid levels and postprandial improvements in breakfast glucose levels possibly due to reduced nocturnal lipolysis (Axelsen et al, 1997(Axelsen et al, ,1999a. A slow-release carbohydrate food taken in the evening can also prevent nocturnal hypoglycemia in patients with insulin-dependent diabetes mellitus (Axelsen et al, 1999b).…”

Breakfast glycaemic response in patients with type 2 diabetes: Effects of bedtime dietary carbohydrates

“…However, the mechanism(s) for the overnight second-meal effect by cornstarch ingestion were not fully elucidated. Since uncooked cornstarch possesses a slow release pro®le in vivo (Axelsen et al, 1999;Chen et al, 1984;Collings et al, 1981;Hayde & Widhalm, 1990;Wolfsdorf & Crigler Jr, 1997), the lente characteristic of the food may be critical in eliciting the overnight secondmeal effect in type 2 diabetic patients.…”