Optimal Carbohydrate Dose for Treatment of Nonsevere Hypoglycemia in Insulin-Treated Patients With Diabetes: A Narrative Review

Urbanová, Jana; Frier, Brian M.; Taniwall, Arian; Brožová, Klára; Malinovská, Jana; Chandel, Aviral; Brož, Jan

doi:10.1016/j.jcjd.2022.03.011

Cited by 1 publication

(4 citation statements)

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“…Advantages of higher initial CHO consumption in some circumstances and treatment at higher glucose thresholds or ranges should be further reproduced in other trials and settings. This study adds to the scarce literature needed to fine-tune the treatment approach for this daily struggle for PWT1D and asserts the need to conduct other trials to cover various clinical scenarios and conditions of NS-H (8). episodes, and the nurses and clinical research personnel at the Montreal Clinical Research Institute for their invaluable work and efforts.…”

Section: Discussionmentioning

confidence: 91%

“…According to the current guidelines, this translates into 73% of participants overtreating their NS-H episodes (more than 20 g within the first 15 min) (4). However, this practice could equally reflect the inefficiency of the current guidelines to meet PWT1D's needs in treating their NS-H (8,9). Thus, we hypothesized that a higher initial CHO consumption than the recommended 15-20 g might be more effective in correcting NS-H and reduce the need to repeated treatments.…”

Section: Introductionmentioning

confidence: 99%

“…They recommend a one-size-fits-all approach of consuming 15-20 g of simple CHO every 15 min until correction (15 g/15 min rule) (1,(5)(6)(7). Same recommendations apply regardless of many factors potentially influencing the response to treatment such as glucose levels during treatment, estimated level of hyper-insulinemia, modality of insulin therapy, body weight, and activity level (8).…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies and review reports have questioned the 15 g/15 min rule and have required extensive research studies to investigate the most efficient treatment strategies according to different NS-H settings and conditions (8). The aim would be to fine-tune NS-H treatment guidelines for PWT1D (4,(8)(9)(10). An observational study, in free-living conditions, of PWT1D's practices showed a mean initial intake of 32 ± 24 g CHO to correct NS-H episodes (4).…”

Section: Introductionmentioning

confidence: 99%

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Non-severe hypoglycemia in type 1 diabetes: a randomized crossover trial comparing two quantities of oral carbohydrates at different insulin-induced hypoglycemia ranges

et al. 2023

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AimsNon-severe hypoglycemia (NS-H) is challenging for people living with type 1 diabetes (PWT1D) and often results from relative iatrogenic hyper-insulinemia. Current guidelines recommend a one-size-fits-all approach of 15–20 g of simple carbohydrates (CHO) every 15 min regardless of the triggering conditions of the NS-H event. We aimed to test different amounts of CHO to treat insulin-induced NS-H at various glucose ranges.MethodsThis is a randomized, four-way, crossover study involving PWT1D, testing NS-H treatment outcomes with 16 g vs. 32 g CHO at two plasma glucose (PG) ranges: A: 3.0–3.5 mmol/L and B: <3.0 mmol/L. Across all study arms, participants consumed an additional 16 g of CHO if PG was still <3.0 mmol/L at 15 min and <4.0 mmol/L at 45 min post-initial treatment. Subcutaneous insulin was used in a fasting state to induce NS-H. Participants had frequent venous sampling of PG, insulin, and glucagon levels.ResultsParticipants (n = 32; 56% female participants) had a mean (SD) age of 46.1 (17.1) years, had HbA1c at 54.0 (6.8 mmol/mol) [7.1% (0.9%)], and had a diabetes duration of 27.5 (17.0) years; 56% were insulin pump users. We compared NS-H correction parameters between 16 g and 32 g of CHO for range A, 3.0–3.5 mmol/L (n = 32), and range B, <3.0 mmol/L (n = 29). Change in PG at 15 min for A: 0.1 (0.8) mmol/L vs. 0.6 (0.9) mmol/L, p = 0.02; and for B: 0.8 (0.9) mmol/L vs. 0.8 (1.0) mmol/L, p = 1.0. Percentage of participants with corrected episodes at 15 min: (A) 19% vs. 47%, p = 0.09; (B) 21% vs. 24%, p = 1.0. A second treatment was necessary in (A) 50% vs. 15% of participants, p = 0.001; (B) 45% vs. 34% of participants, p = 0.37. No statistically significant differences in insulin and glucagon parameters were observed.ConclusionsNS-H, in the context of hyper-insulinemia, is difficult to treat in PWT1D. Initial consumption of 32 g of CHO revealed some advantages at the 3.0–3.5 mmol/L range. This was not reproduced at lower PG ranges since participants needed additional CHO regardless of the amount of initial consumption.Clinical trial registrationClinicalTrials.gov, identifier NCT03489967.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%