Hypoglycemia treatment advice needs modifying for low-glucose suspend systems
medwireNews: The amount of carbohydrate needed to treat mild or moderate hypoglycemia in people with type 1 diabetes using a predictive low-glucose suspend system may be considerably lower than what is currently recommended, report researchers.
“Avoiding overtreatment of hypoglycemia may avoid subsequent hyperglycemia and increased glycemic variability while preventing unnecessary caloric intake from [carbohydrate],” say Jordan Pinsker (Sansum Diabetes Research Institute, Santa Barbara, California, USA) and study co-authors.
Current recommendations are to use 15–20 g of glucose or carbohydrate to treat mild or moderate hypoglycemia in people with type 1 diabetes. But the team notes that even this advice is “supported by very limited quality evidence.”
In this overnight inpatient study, 10 people already using an insulin pump were placed on a predictive low-glucose suspend insulin delivery system. Following a low-fat meal, insulin delivery was increased until it triggered the low-glucose suspend function.
During monitoring, which lasted until after breakfast the following morning, the study participants had a total of 59 low-glucose suspend events, just seven of which required carbohydrate treatment.
The amount of carbohydrate administered by the investigators in these cases ranged from 5 to 16 g, with an average of 9.9 g. Based on the amount of insulin suspension time, the researchers calculated that an average of 14 g additional carbohydrate would have been required had insulin delivery continued.
Carbohydrate treatment resulted in an average blood glucose increase of 54.5 mg/dL (3.02 mmol/L). The highest amount of carbohydrate, of 16 g, was administered in two instances, resulting in blood glucose increases of 75 and 105 mg/dL (4.2 and 5.8 mmol/L) and taking the level up to around 125 and 170 mg/dL (6.9 and 9.4 mmol/L), respectively.
Although they believe their findings point to the need for guideline adjustment, the researchers caution: “Careful research, clinician experience, and guideline changes may, by themselves, be insufficient to avoid overtreatment of hypoglycemia when preceded by insulin suspension.”
Writing in Diabetes Technology & Therapeutics, they say: “Patients may continue to overtreat hypoglycemia secondary to fear of hypoglycemia, desire to limit the unpleasant sensations caused by hypoglycemia, or [continuous glucose monitoring] lag time.
“Thus, clinicians will need to provide explicit and likely repeated retraining on the amount of [carbohydrate] needed when hypoglycemia is preceded by insulin suspension.”
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