Effect of carbohydrate treatment on mild symptomatic hypoglycaemia, assessed by continuous glucose monitoring

Abstract

Abstract

Background: Appropriate self-treatment of mild symptomatic hypoglycaemia is essential to prevent severe hypoglycaemia. Danish national guidelines recommend 10–20 g of refined carbohydrate (CH) initially, followed by a non-specified amount of unrefined CH.

Aim: Our aim was to explore the effect of the amount of CH taken on glucose concentrations recorded by the MiniMed Continuous Glucose Monitoring System (CGMS) at mild symptomatic hypoglycaemic episodes.

Method: A total of 125 adult patients with type 1 diabetes underwent 6 days of CGMS. HemoCue blood glucose determinations were used for calibration. All mild symptomatic episodes with a concomitant CGMS value ≤3.5 mmol/l were included in the analysis. Participants completed a detailed diary documenting all meals and snacks, insulin doses, and episodes and self-treatment of hypoglycaemia. CGMS values recorded 30 and 60 minutes after the episode were compared to CH intake. An initial intake of <10 g CH was defined as under treatment, and an intake of >20 g CH as over treatment. Treatment target was CGMS values of 3.6–10.0 mmol/l; values ≤3.5 mmol/l were defined as insufficient treatment, and values >10.0 mmol/l as overshooting the target.

Results: A total of 126 mild symptomatic episodes was experienced in 52 (42%) of the patients. Initial carbohydrate intake could be calculated for 93 episodes. At 30 minutes, under treatment was associated with increased risk of insufficient response (57% versus 30%; p<0.01). At 60 minutes, over treatment was associated with increased risk of overshooting the target (23% versus 7%; p<0.05). An independent effect of follow-up intake of unrefined CH is not detectable within the first 60 minutes after treatment.

Conclusion: Current guidelines for treatment of mild symptomatic hypoglycaemia are appropriate to ensure achievement of the glycaemic target.