Improving the body’s response during hypoglycemia in type 1 diabetes

This study examined whether diazoxide (Proglycem) can improve awareness of low blood glucose (sugar) in type 1 diabetic patients.

Patients with type 1 diabetes do not produce the hormone insulin, which is needed to break down the glucose taken in from food. The main treatment for type 1 diabetics is insulin replacement to control blood glucose. However, insulin therapy can increase the risk of hypoglycemia (dangerously low blood glucose).

Most patients can sense that blood glucose levels are dropping, while other patients have impaired awareness of this. Falling blood glucose levels normally trigger the release of epinephrine (adrenalin). Epinephrine leads to physical symptoms including increased heartbeat, sweating and shakiness. However, low levels of epinephrine despite falling glucose levels can decrease patients’ awareness and increase the risk of dangerously low blood glucose.

The drug diazoxide affects the ability of signals to reach the brain. Diazoxide allows signals to more easily access the brain, causing the brain to become more aware of low levels of glucose and cause an appropriate response. It is therefore thought that diazoxide may improve awareness of hypoglycemia in type 1 diabetic patients.

This study examined whether diazoxide can improve awareness of hypoglycemia in type 1 diabetic patients. Twelve patients were randomly assigned to receive either diazoxide or a placebo (a substance with no effect on the body used as a comparison). After the treatment they were given a mixture of glucose and insulin to slowly cause hypoglycemia. Epinephrine levels, heart rate, and blood pressure were measured during the study. 

Hypoglycemia caused epinephrine levels to increase by 37% more after diazoxide than after the placebo. This indicated that the brain was more aware of hypoglycemia in diazoxide recipients and was releasing more epinephrine in response. Though glucose levels did not have to fall as far in those taking diazoxide compared to those taking placebo to cause an increase in epinephrine, this was not statistically significant. There were no differences in blood pressure or heart rate measurements between the two groups.

During the study some patients did not respond to diazoxide. They had a mutation (genetic abnormality) in the potassium channels needed for sensing hypoglycemia. The patients who responded best to diazoxide did not have the mutation.

This study concluded that diazoxide allowed the brain to more easily detect low glucose levels as evidenced seen by increased release of epinephrine. This may improve the body’s ability to display physical symptoms of hypoglycemia and potentially increase patient awareness.

This was a very small study and needs to be repeated to determine whether the results can be generalized to a larger population.

Remaining unaware of hypoglycemia can be very dangerous; talk to your doctor about the signs and symptoms you should be looking out for when you may be hypoglycemic.