Low blood sugar at night still a diabetes problem

Reuters Health, Friday, June 30, 2006
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 say.
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.