Hypoglycemic episodes

Nonselective beta-blockers may delay recovery from hypoglycemic episodes and mask their signs/symptoms. Cardioselective agents may be alternatives, ay sometimes be followed by hyperglycemia. ... 

Take glucose rather than complex carbohydrates to abort hypoglycemic episodes... 

Effect of tight glucose control on hypoglycemic episodes in a population of patients on intensive therapy or conventional therapy. 

When acarbose is combined with insulin, the greatest effects are seen with regimens that involve only once- or twice-daily administration. The alpha-glucosidase inhibitors seem to be less effective when they are combined with intensive insulin therapy (35). In combination with insulin or oral hypoglycemic drugs the frequency of hypoglycemic episodes can increase sucrose or higher carbohydrates are reported to be less effective, which can be understood from the mechanism of action. 

However, in a double-blind study in 100 patients with compensated non-alcoholic liver cirrhosis and type 2 diabetes, acarbose for 28 weeks did not alter liver function (64). The number of hypoglycemic episodes was reduced. 

In a double-blind, crossover study of insulin aspart or soluble human insulin before meals and protamine zinc insulin before bedtime, 90 of 104 patients with type 1 diabetes completed the trial (5). Insulin aspart improved postprandial control by reducing hyperglycemic and hypoglycemic variations, but night-time control was inferior. There were 547 hypoglycemic episodes in the aspart... 

In 619 patients with type 1 diabetes treated with protamine zinc insulin and insulin lispro, randomized to once-daily insulin glargine or to once-daily or twice-daily protamine zinc insulin for 16 weeks in an open study, there was no difference in the frequency of hypoglycemic episodes, severe hypoglycemia, or HbAic (25). Fasting plasma glucose concentrations were lower with insulin glargine. 

In an open, randomized, crossover study, 113 patients with at least 6 months of continuous subcutaneous insulin infusion before the study were treated with regular insulin or insulin lispro (2). Postprandial blood glucose was lower and HbAlc fell more with insulin lispro. There were no differences in catheter obstruction, hypoglycemic episodes, or other adverse effects. Satisfaction with treatment was better with insulin lispro. 

Insulin aspart, insulin lispro, and buffered regular insulin in continuous subcutaneous insulin infusion have been compared in an open, randomized, parallel-group study in 146 patients (24). HbAlc, hypoglycemic episodes, and blockages of pumps or infusion sets did not differ. 

However, contrary to popular belief, beta-adrenoceptor antagonists do not by themselves increase the risk of hypoglycemic episodes in insulin-treated diabetics, in whom their use was concluded to be generally safe (192). Indeed, in 20 such patients treated with diet or diet plus oral hypoglycemic agents, both propranolol and metoprolol produced small but significant increases in blood... 

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