Skip to main content
SpringerLink
Log in

Treatment of mild-to-moderate hypoglycemia in patients with type 1 diabetes treated with insulin pump therapy: are current recommendations effective?

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aims

Mild-to-moderate hypoglycemia (blood glucose < 4.0 mmol/L) is recommended to be treated with 15 g of carbohydrates and to repeat the treatment if hypoglycemia persists after 15 min. This recommendation was established before intensive insulin therapy and based on studies using insulin with different pharmacokinetic profiles from actual insulin analogs showing that 15 g of glucose increases blood glucose by ~ 1.5 mmol/L in 15 min. We aimed to explore the effect of current recommended treatment of mild-to-moderate hypoglycemia in type 1 diabetes (T1D) participants and factors associated with treatment effectiveness.

Methods

This is a secondary analysis from three observational inpatient studies with a standardized and supervised treatment (16 g carbohydrates) of hypoglycemia (< 3.3 mmol/L with symptoms or < 3.0 mmol/L without symptom) in participants (47 adults–10 adolescents) with T1D using continuous subcutaneous insulin infusion (“insulin pumps”; CSII)).

Results

Twenty-seven participants presented a total of 48 hypoglycemia episodes treated by a single intake of 16 g of carbohydrates. Time required for normoglycemia recovery was 19.5 ± 12.0 min. The rise in plasma glucose following treatment was 0.85 ± 0.66 mmol/L in 15 min. Eighteen episodes (38%) were resolved (> 4.0 mmol/L) 15-min post-treatment. Glycemia at the time of treatment (< 3.2 mmol/L; p < 0.001) and a higher proportion of total daily insulin from basal doses (p = 0.03) were associated with a slower post-treatment plasma glucose rise.

Conclusions

These results raise the possibility that sixteen grams of carbohydrates could be insufficient to treat a large proportion of hypoglycemia episodes in T1D patients treated with CSII. Factors affecting treatment effectiveness need to be investigated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329(14):977–986

    Article  Google Scholar 

  2. Clayton D, Woo V, Yale JF, Canadian Diabetes Association Clinical Practice Guidelines Expert C (2013) Hypoglycemia. Can J Diabetes 37(Suppl 1):S69–S71

    Article  PubMed  Google Scholar 

  3. Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H (2008) Barriers to physical activity among patients with type 1 diabetes. Diabetes Care 31(11):2108–2109

    Article  PubMed  PubMed Central  Google Scholar 

  4. American Diabetes Association (2016) Standards of medical care in diabetes. Diabetes Care 39(Suppl. 1):S72–S80

    Google Scholar 

  5. Banck-Petersen P, Larsen T, Pedersen-Bjergaard U, Due-Andersen R, Høi-Hansen T, Thorsteinsson B (2007) Adherence to guidelines for self-treatment of mild hypoglycaemia in type 1 diabetes. Eur Diabetes Nurs 4(1):18–22

    Article  Google Scholar 

  6. Sally A, Vindedziz BM, Sherriff JL, Dhaliwal SS, Stanton KG (2012) Food selection for treatment of hypoglycaemia in insulin-treated diabetes: what happens in real life? Pract Diabetes 29(7):271–274

    Article  Google Scholar 

  7. Savard V, Gingras V, Leroux C, Bertrand A, Desjardins K, Mircescu H, Rabasa-Lhoret R (2016) Treatment of hypoglycemia in adult patients with type 1 diabetes: an observational study. Can J Diabetes 40(4):318–323

    Article  PubMed  Google Scholar 

  8. Haidar A, Legault L, Messier V, Mitre TM, Leroux C, Rabasa-Lhoret R (2015) Comparison of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy for glycaemic control in patients with type 1 diabetes: an open-label randomised controlled crossover trial. Lancet Diabetes Endocrinol 3(1):17–26

    Article  CAS  PubMed  Google Scholar 

  9. Haidar A, Legault L, Dallaire M, Alkhateeb A, Coriati A, Messier V, Cheng P, Millette M, Boulet B, Rabasa-Lhoret R (2013) Glucose-responsive insulin and glucagon delivery (dual-hormone artificial pancreas) in adults with type 1 diabetes: a randomized crossover controlled trial. CMAJ 185(4):297–305

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gingras V, Rabasa-Lhoret R, Messier V, Ladouceur M, Legault L, Haidar A (2016) Efficacy of dual-hormone artificial pancreas to alleviate the carbohydrate-counting burden of type 1 diabetes: a randomized crossover trial. Diabetes Metab 42(1):47–54

    Article  CAS  PubMed  Google Scholar 

  11. Slama G, Traynard PY, Desplanque N, Pudar H, Dhunputh I, Letanoux M, Bornet FR, Tchobroutsky G (1990) The search for an optimized treatment of hypoglycemia. Carbohydrates in tablets, solution, or gel for the correction of insulin reactions. Arch Intern Med 150(3):589–593

    Article  CAS  PubMed  Google Scholar 

  12. Brodows RG, Williams C, Amatruda JM (1984) Treatment of insulin reactions in diabetics. JAMA 252(24):3378–3381

    Article  CAS  PubMed  Google Scholar 

  13. The Diabetes Control and Complications (DCCT) Research Group (1995) Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 47(6):1703–1720

  14. Diabetes Control and Complications Trial Research Group (2001) Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial. Diabetes Care 24(10):1711–1721

    Article  Google Scholar 

  15. Wong JC, Foster NC, Maahs DM, Raghinaru D, Bergenstal RM, Ahmann AJ, Peters AL, Bode BW, Aleppo G, Hirsch IB et al (2014) Real-time continuous glucose monitoring among participants in the T1D exchange clinic registry. Diabetes Care 37(10):2702–2709

    Article  PubMed  PubMed Central  Google Scholar 

  16. Benkhadra K, Alahdab F, Tamhane S, Wang Z, Prokop LJ, Hirsch IB, Raccah D, Riveline JP, Kordonouri O, Murad MH (2017) Real-time continuous glucose monitoring in type 1 diabetes: a systematic review and individual patient data meta-analysis. Clin Endocrinol (Oxf) 86(3):354–360

    Article  Google Scholar 

  17. King AB, Kuroda A, Matsuhisa M, Hobbs T (2016) A review of insulin-dosing formulas for continuous subcutaneous insulin infusion (CSII) for adults with type 1 diabetes. Curr Diab Rep 16(9):83

    Article  PubMed  PubMed Central  Google Scholar 

  18. McTavish L, Krebs JD, Weatherall M, Wiltshire E (2015) Weight-based hypoglycaemia treatment protocol for adults with Type 1 diabetes: a randomized crossover clinical trial. Diabet Med 32(9):1143–1148

    Article  CAS  PubMed  Google Scholar 

  19. Vindedzis S, Marsh B, Sherriff J, Dhaliwal S, Stanton K (2012) Dietary treatment of hypoglycaemia: should the Australian recommendation be increased? Intern Med J 42(7):830–833

    Article  CAS  PubMed  Google Scholar 

  20. Cryer PE, Davis SN, Shamoon H (2003) Hypoglycemia in diabetes. Diabetes Care 26(6):1902–1912

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to all participants from the studies that were included in this secondary analysis. The J-A DeSève Foundation to RRL supported this analysis, while data collection was supported by studies funded by Diabetes Canada, Diabète Québec and the Canadian Institute for Health Research operating grants to RRL. VG is a research scholar of FRQS (Fonds de Recherche du Québec en Santé). MRS was supported by a postdoctoral fellowship from the Fonds de Recherche du Québec Nature et Technologies (FRQNT).

Author information

Authors and Affiliations

  1. Institut de recherches cliniques de Montréal (IRCM), 110 avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada

    Véronique Gingras, Katherine Desjardins, Valérie Savard, Virginie Messier & Rémi Rabasa-Lhoret

  2. Department of Nutrition, Université de Montréal, Montreal, QC, Canada

    Véronique Gingras, Mohamed Raef Smaoui, Valérie Savard & Rémi Rabasa-Lhoret

  3. Department of Biomedical Engineering, McGill University, Montreal, QC, Canada

    Ahmad Haidar

  4. Division of Endocrinology, McGill University, Montreal, QC, Canada

    Ahmad Haidar

  5. Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada

    Laurent Legault

  6. Research Center, Université de Montréal Hospital Center (CRCHUM), Montreal, QC, Canada

    Rémi Rabasa-Lhoret

  7. Montreal Diabetes Research Center (MDRC), Montreal, QC, Canada

    Rémi Rabasa-Lhoret

Authors
  1. Véronique Gingras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Desjardins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohamed Raef Smaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valérie Savard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Virginie Messier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmad Haidar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laurent Legault
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rémi Rabasa-Lhoret
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rémi Rabasa-Lhoret.

Ethics declarations

Conflict of interest

RRL has received consultant/speaker honorariums and/or his institution received grants from Astra-Zeneca, Becton–Dickinson, Bohringer, Eli Lilly, Janssen, Insulet, Lifescan, Medtronic, Merck, Novartis, Neomed, Novo Nordisk, Roche, Sanofi-Aventis, Takeda and Valeant. AH has received consultant fees and grants from Medtronic, Eli Lilly and AgaMatrix. LL has received consultant/speaker honorariums and/or his institution received grants from Eli Lilly, Medtronic, Novo Nordisk, Merck and Sanofi. No other competing financial interests were reported.

Human and animal rights

All procedures performed in the initial studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The IRCM ethics committee approved the studies and all participants gave their informed consent prior to their inclusion in the studies.

Additional information

Managed By Massimo Federici.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 222 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gingras, V., Desjardins, K., Smaoui, M.R. et al. Treatment of mild-to-moderate hypoglycemia in patients with type 1 diabetes treated with insulin pump therapy: are current recommendations effective?. Acta Diabetol 55, 227–231 (2018). https://doi.org/10.1007/s00592-017-1085-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-017-1085-8

Keywords

Search

Navigation