Low Carbohydrate Diet Impairs the Effect of Glucagon in the Treatment of Insulin-Induced Mild Hypoglycemia: A Randomized Cross-Over Study.

OBJECTIVE This study compared the ability of glucagon to restore plasmaglucose (PG) after mild hypoglycemia in patients with type 1 diabetes on an isocaloric high-carbohydrate diet (HCD) versus a low-carbohydrate diet (LCD). RESEARCH DESIGN AND METHODS Ten patients with insulin pump-treated type 1 diabetes randomly completed 1 week of the HCD (>= 250 g/day) and 1 week of the LCD (<= 50 g/day). After each week, mild hypoglycemia was induced by a subcutaneous insulin bolus in the fasting state. When PG reached 3.9 mmol/L, 100 mu g glucagon was given subcutaneously, followed by 500 mu g glucagon 2 h later. RESULTS Compared with the HCD, the LCD resulted in lower incremental rises in PG after the first (mean +/- SEM: 1.3 +/- 0.3 vs. 2.7 +/- 0.4 mmol/L, P = 0.002) and second glucagon bolus (4.1 +/- 0.2 vs. 5.6 +/- 0.5 mmol/L, P = 0.002). No differences were observed between the diets regarding concentrations of insulin, glucagon, and triglycerides. CONCLUSIONS The LCD reduces the treatment effect of glucagon on mild hypoglycemia. Carbohydrate intake should be considered when low-dose glucagon is used to correct hypoglycemia.