Type 1 Diabetes
Conditions
Keywords
Hypoglycemia, carbohydrates
Brief summary
According to guidelines, when a mild-to-moderate hypoglycemia occurs (capillary blood glucose \< 4.0 mmol/L), 15-20g of rapidly absorbed carbohydrates should be ingested. Patients should re-test and re-ingest 15-20g carbohydrates every 15 minutes until they recover from hypoglycemia. These recommendations were principally based on two studies conducted in the 80s before the introduction of intensive insulin therapy secondary to the DCCT trial and with insulin formulations with largely different pharmacokinetic profiles from current insulin analogs. Recent studies suggest that with current insulin analogs and intensive therapeutic approach, 15g of carbohydrates may be insufficient to rapidly correct an important proportion of hypoglycemic episodes. It is thus important to determine if the recommended hypoglycemia treatment remains the recommendation.
Interventions
OTHERInduced-hypoglycemia test
Participants will be admitted at the research center at 7:00 after an overnight fast. A venous catheter will be inserted into an arm vein for blood sampling purposes. A subcutaneous insulin bolus will be administered to induce hypoglycemia. Oral treatment (16g of carbohydrates or 32g of carbohydrates) will be given when plasma glucose levels are at the target threshold of \< 3.0 mmol/L or 3.0-3.5 mmol/L. Hypoglycemia symptoms will be assessed every 10 minutes by the participant using a validated scale starting from the time of insulin bolus until hypoglycemia recovery. One hour after hypoglycemia recovery, a standardized meal will be given.
Sponsors
Institut de Recherches Cliniques de Montreal
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Males and females ≥ 18 years of old. 2. Clinical diagnosis of type 1 diabetes for at least one year. 3. Treatment with multiple daily insulin injections or insulin pump therapy and using insulin analogs (rapid, ultra-rapid and basal). 4. HbA1c ≤ 10%.
Exclusion criteria
1. Clinically significant microvascular complications: nephropathy (estimated glomerular filtration rate below 40 ml/min), neuropathy (especially diagnosed gastroparesis) or severe proliferative retinopathy as judged by the investigator. 2. Recent (\< 3 months) acute macrovascular event e.g. acute coronary syndrome or cardiac surgery. 3. Known significant cardiac rhythm abnormality based on investigator judgment. 4. Abnormal blood panel and/or anemia (Hb \< 100g/L). 5. Ongoing pregnancy or breastfeeding. 6. Severe hypoglycemic episode within 1 month of screening. 7. Known uncorrected hypokalemia (potassium \< 3.5 mmol/L; available within the past 3 months).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in glucose levels 15 minutes after hypoglycemic treatment | 15 minutes after hypoglycemic treatment | Change in glucose levels 15 minutes after hypoglycemic treatment (16g vs. 32g of carbohydrates) when glucose levels at the time of treatment are below 3.0 mmol/L or between 3.0 and 3.5 mmol/L. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in glucose levels 60 minutes after hypoglycemic treatment | 60 minutes after hypoglycemic treatment | Change in glucose levels 60 minutes after hypoglycemic treatment (16g vs. 32g of carbohydrates) when glucose levels at the time of treatment are below 3.0 mmol/L or between 3.0 and 3.5 mmol/L. |
| Number of participants with glucose levels above 8.0 mmol/L 1 hour after hypoglycemia correction | 60 minutes after hypoglycemia correction | — |
| Change in glucose levels 30 minutes after hypoglycemic treatment | 30 minutes after hypoglycemic treatment | Change in glucose levels 30 minutes after hypoglycemic treatment (16g vs. 32g of carbohydrates) when glucose levels at the time of treatment are below 3.0 mmol/L or between 3.0 and 3.5 mmol/L. |
| Change in glucose levels 45 minutes after hypoglycemic treatment | 45 minutes after hypoglycemic treatment | Change in glucose levels 45 minutes after hypoglycemic treatment (16g vs. 32g of carbohydrates) when glucose levels at the time of treatment are below 3.0 mmol/L or between 3.0 and 3.5 mmol/L. |
| Number of participants with glucose levels above 10.0 mmol/L 1 hour after hypoglycemia correction | 60 minutes after hypoglycemia correction | — |
| Glucose levels 60 minutes after meal consumption | 60 minutes after meal consumption | — |
| Number of patients for whom hypoglycemia was corrected 25 minutes after hypoglycemic treatment | 25 minutes after hypoglycemic treatment | — |
| Glucose levels 90 minutes after meal consumption | 90 minutes after meal consumption | — |
| Number of patients for whom hypoglycemia was corrected 10 minutes after hypoglycemic treatment | 10 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia was corrected 15 minutes after hypoglycemic treatment | 15 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia was corrected 20 minutes after hypoglycemic treatment | 20 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia was corrected 30 minutes after hypoglycemic treatment | 30 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia was corrected 35 minutes after hypoglycemic treatment | 35 minutes after hypoglycemic treatment | — |
| Change in glucose levels 20 minutes after hypoglycemic treatment | 20 minutes after hypoglycemic treatment | Change in glucose levels 20 minutes after hypoglycemic treatment (16g vs. 32g of carbohydrates) when glucose levels at the time of treatment are below 3.0 mmol/L or between 3.0 and 3.5 mmol/L. |
| Number of hypoglycemic events corrected 15 minutes after hypoglycemic treatment | 15 minutes after hypoglycemic treatment | — |
| Number of hypoglycemic events corrected 20 minutes after hypoglycemic treatment | 20 minutes after hypoglycemic treatment | — |
| Number of hypoglycemic events corrected 25 minutes after hypoglycemic treatment | 25 minutes after hypoglycemic treatment | — |
| Number of hypoglycemic events corrected 30 minutes after hypoglycemic treatment | 30 minutes after hypoglycemic treatment | — |
| Number of hypoglycemic events corrected 35 minutes after hypoglycemic treatment | 35 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 10 minutes after hypoglycemic treatment | 10 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 15 minutes after hypoglycemic treatment | 15 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 20 minutes after hypoglycemic treatment | 20 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 25 minutes after hypoglycemic treatment | 25 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 30 minutes after hypoglycemic treatment | 30 minutes after hypoglycemic treatment | — |
| Number of patients for whom hypoglycemia symptoms disappeared 35 minutes after hypoglycemic treatment | 35 minutes after hypoglycemic treatment | — |
| Number of patients requiring a second treatment 40 minutes after the first hypoglycemic treatment | 40 minutes after the first hypoglycemic treatment | — |
| Number of patients requiring a second treatment 15 minutes after the first hypoglycemic treatment | 15 minutes after the first hypoglycemic treatment | — |
| Number of hypoglycemic events corrected 10 minutes after hypoglycemic treatment | 10 minutes after hypoglycemic treatment | — |
Countries
Canada
Outcome results
None listed