title: beta-adrenergic blockade and diabetes mellitus. A review.
abstract: The use of beta-blockers in diabetes mellitus has largely been restricted because of the reported adverse effects. Clinical investigations aimed at elucidating the possible reactions associated with the use of beta-blockers have disclosed no evidence of masking or signs or insulin-induced hypoglycaemia or potentiation of the insulin effect. Prolonged hypoglycaemia may develop, however, as a result of physical effort. There is no proof that during insulin-induced hypoglycaemia the concentrations of counter-regulatory hormones are depressed, but that of glycerol, a gluconeogenic precursor, is slightly diminished. Intensification of the hypertensive reaction during hypoglycaemia is less likely to occur during treatment with beta-selective blockers. In insulin-dependent diabetics receiving beta 1-blockers there is no evidence of any change - either deterioration or improvement - in metabolic control. In one small controlled trial there was no sign of impairment of the peripheral arterial circulation over a short period of administration of a non-selective beta-blocker. In general, for patients suffering from insulin-dependent diabetes, cardioselective agents are preferable. Since cardioselectivity is a dose-dependent property, reasonable caution should also be observed when using this type of drug in diabetes.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000526:Alprenolol / Q000009:adverse effects; D001786:Blood Glucose / Q000378:metabolism; D002395:Catecholamines / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000188:drug therapy; D004357:Drug Synergism; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005943:Gluconeogenesis / Q000187:drug effects; D005951:Glucose Tolerance Test; D005990:Glycerol / Q000097:blood; D006003:Glycogen / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced; D007328:Insulin / Q000009:adverse effects; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008790:Metoprolol / Q000009:adverse effects; D010096:Oxprenolol / Q000009:adverse effects; D011433:Propranolol / Q000009:adverse effects
chemical_list: D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D002395:Catecholamines; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D007773:Lactates; D019344:Lactic Acid; D010096:Oxprenolol; D000526:Alprenolol; D006003:Glycogen; D011433:Propranolol; D008790:Metoprolol; D005990:Glycerol