June 30, 2006

Low blood sugar at night still a diabetes problem

By David Douglas

NEW YORK (Reuters Health) - For people with type 1 diabetes
who aim to keep their blood sugar levels under tight control,
nighttime can bring the problem of sugar levels dropping too
low -- which can lead to mental confusion or even seizures.
None of the available remedies, however, are ideal, researchers

Bedtime snacks are not a reliable method of preventing
nocturnal hypoglycemia, as the condition is called, and drug
treatment has shortcomings, according to a report in the June
issue of the Journal of Clinical Endocrinology and Metabolism.

"Nocturnal hypoglycemia is a problem for many people with
diabetes that has not been solved," Dr. Philip E. Cryer told
Reuters Health.

To investigate possible bedtime solutions, Cryer and
colleagues at Washington University School of Medicine, St.
Louis, Missouri studied 21 patients with type-1 diabetes over
five nights.

On different nights they were assigned to receive no
treatment, an uncooked cornstarch bar, a snack, a snack and the
drug acarbose, or a dose of terbutaline. Cornstarch is intended
to provide a slowly digested source of carbohydrate, and
acarbose slows the digestion of carbohydrates. Terbutaline
stimulates production of epinephrine, which in turn may counter
falling glucose levels.

"We found that a conventional bedtime snack (with or
without acarbose), or bedtime ingestion of uncooked cornstarch,
did not consistently prevent nocturnal hypoglycemia in people
with type 1 diabetes," Cryer said.

For practical purposes, "terbutaline prevented nocturnal
hypoglycemia, but it also caused hyperglycemia (excessively
high glucose levels) the following morning."

In light of this, Dr. Cryer concluded, "we need to find out
if a lower dose of terbutaline would be effective in preventing
nocturnal hypoglycemia without causing morning hyperglycemia."

SOURCE: Journal of Clinical Endocrinology and Metabolism,
June 2006.