Preventing low blood sugar at night

For people with type 1 diabetes who aim to keep their blood sugar levels under tight control, night time can bring the problem of sugar levels dropping too low - which can lead to mental confusion or even seizures. Bedtime snacks are not a reliable method of preventing nocturnal hypoglycaemia, as the condition is called, and drug treatment has shortcomings. Nocturnal hypoglycaemia is a problem for many people with diabetes that has not been solved.To investigate possible bedtime solutions, researchers at Washington University School of Medicine, USA, 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.

It was found that a conventional bedtime snack (with or without acarbose), or bedtime ingestion of uncooked cornstarch, did not consistently prevent nocturnal hypoglycaemia in people with type 1 diabetes. For practical purposes, terbutaline prevented nocturnal hypoglycaemia, but it also caused hyperglycemia (excessively high glucose levels) the following morning.In light of this, the researchers concluded that there is need to find out if a low dose of terbutaline would be effective in preventing nocturnal hypoglycaemia without causing morning hyperglycaemia.

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